Healthcare Provider Details

I. General information

NPI: 1700043155
Provider Name (Legal Business Name): CHARLES WALTER DEBROSSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8039 WASHINGTON VILLAGE DR, SUITE 100
DAYTON OH
45458
US

IV. Provider business mailing address

8039 WASHINGTON VILLAGE DR, SUITE 100, DAYTON, OH 45458
DAYTON OH
45458
US

V. Phone/Fax

Practice location:
  • Phone: 937-435-8999
  • Fax: 937-435-4211
Mailing address:
  • Phone: 937-435-8999
  • Fax: 937-435-4211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.089171
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number35-089171
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: