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General NPI Number Information
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NPI Number | 1447676127
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Entity Type | Individual
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Provider Name | ROBERT LOUIS DEBERNARDO SR. M.D., MPH
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Gender | Male
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Dates
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Enumeration Date | 03/05/2014
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Last Update Date | 03/05/2014
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Provider Practice Location Address
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Address Line | 15 ESSEX LN
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City | TRUMBULL
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State | CT
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Zip | 06611-1005
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Country | US
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Telephone | 203-522-7249
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Fax |
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Provider Business Mailing Address
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Address Line | 15 ESSEX LN
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City | TRUMBULL
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State | CT
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Zip | 06611-1005
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Country | US
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Telephone | 203-522-7249
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | 015004
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207RA0201X
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Taxonomy Name | Allergy & Immunology (Internal Medicine) Physician
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License Number | 015004
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License Number State | CT
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