Healthcare Provider Details

I. General information

NPI: 1710031844
Provider Name (Legal Business Name): LARRY DEUTSCH MD MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 PHOENIX AVE
WATERBURY CT
06702-1418
US

IV. Provider business mailing address

80 PHOENIX AVE
WATERBURY CT
06702-1418
US

V. Phone/Fax

Practice location:
  • Phone: 203-756-8021
  • Fax:
Mailing address:
  • Phone: 203-756-8021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number021505
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: