Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 25MB07415400 | NJ |
N | 207VE0102X | Reproductive Endocrinologist | 25MB07415400 | NJ |
NPI | 1457334047 |
---|---|
Provider Name | Deanna R. Brasile |
First Address | Marlton, NJ 08053-3209 |
Second Address | Marlton, NJ 08053-3209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2005 |
Last Update Date | 15/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I17756 | (02) |