Provider Demographics
NPI:1801856687
Name:BONWETSCH, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BONWETSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 SAND PIT RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4004
Mailing Address - Country:US
Mailing Address - Phone:203-748-2551
Mailing Address - Fax:
Practice Address - Street 1:69 SAND PIT RD
Practice Address - Street 2:SUITE 300
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4004
Practice Address - Country:US
Practice Address - Phone:203-748-2551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0429142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTI28050Medicare UPIN
CT130000632Medicare ID - Type Unspecified