Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | 015004 | CT |
Y | 207RA0201X | Internist - Allergy & Immunology | 015004 | CT |
NPI | 1447676127 |
---|---|
Provider Name | Dr. Robert Louis Debernardo SR. |
First Address | Trumbull, CT 06611-1005 |
Second Address | Trumbull, CT 06611-1005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2014 |
Last Update Date | 05/03/2014 |