=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043646821
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEBORAH LOIS SCHROTER, M.D., LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2013
-----------------------------------------------------
Last Update Date | 09/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26 ELM STREET 3RD FLOOR
-----------------------------------------------------
City | NEW HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-776-1224
-----------------------------------------------------
Fax | 203-776-1225
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26 ELM STREET 3RD FLOOR
-----------------------------------------------------
City | NEW HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-776-1224
-----------------------------------------------------
Fax | 203-776-1225
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSCIATRIST
-----------------------------------------------------
Name | DEBORAH LOIS SCHROTER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 203-776-1224
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 035343
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------