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General NPI Number Information
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NPI Number | 1710169404
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Entity Type | Organization
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Legal Business Name | ALAN BRAVERMAN, MD, PC
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 11 GROVE ST BOOTH HOUSE
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City | NEW MILFORD
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State | CT
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Zip | 06776-3626
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Country | US
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Telephone | 860-354-5511
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Fax | 860-350-3122
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Provider Business Mailing Address
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Address Line | 11 GROVE ST BOOTH HOUSE
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City | NEW MILFORD
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State | CT
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Zip | 06776-3626
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Country | US
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Telephone | 860-354-5511
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Fax | 860-350-3122
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALAN BRAVERMAN
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Credential | MD
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Telephone | 860-354-5511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 021985
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 021985
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License Number State | CT
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