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General NPI Number Information
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NPI Number | 1679648281
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Entity Type | Individual
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Provider Name | ROBERT DETTMER MD
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Gender | Male
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 32 STRAWBERRY HILL CT
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City | STAMFORD
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State | CT
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Zip | 06902-2594
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Country | US
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Telephone | 203-348-5355
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Fax |
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Provider Business Mailing Address
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Address Line | 316 COURTLAND AVE
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City | STAMFORD
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State | CT
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Zip | 06906-2269
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Country | US
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Telephone | 203-348-5355
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 038509
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License Number State | CT
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