=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710918032
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBRA SCHWAB BRANDT D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 KENNEDY DR
-----------------------------------------------------
City | TORRINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06790-3096
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-482-5384
-----------------------------------------------------
Fax | 860-496-4951
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 KENNEDY DR
-----------------------------------------------------
City | TORRINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06790-3096
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-482-5384
-----------------------------------------------------
Fax | 860-489-1799
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 000418
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------