Individual
DR. MYRIAM I DEBAETS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
276 MONTAUK AVE, NEW LONDON, CT 06320-4727
(860) 443-7907
Mailing address
276 MONTAUK AVE, NEW LONDON, CT 06320-4727
(860) 443-7907
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
048342
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649331919
—
CT
01
—
D400012863
MEDICARE NATIONAL GOVERNMENT SERVICES
CT
Enumeration date
12/12/2006
Last updated
03/18/2013
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