MEDICARE: MR. CHARLES WALTER DEBROSSE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	35.089171	OH
2	207K00000X	Allergy & Immunology Physician	35-089171	OH

General Provider Information

NPI Number	:	1700043155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES WALTER DEBROSSE M.D.

Provider Business Mailing Address
First Line	:	8039 WASHINGTON VILLAGE DR, SUITE 100, DAYTON, OH 45458
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458
Country	:	US
Telephone Number	:	937-435-8999
Fax Number	:	937-435-4211

Provider Business Practice Location Address
First Line	:	8039 WASHINGTON VILLAGE DR, SUITE 100
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458
Country	:	US
Telephone Number	:	937-435-8999
Fax Number	:	937-435-4211

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	03/17/2026

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Directions to “ MR. CHARLES WALTER DEBROSSE M.D.” Practice Location

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