Provider Demographics
NPI:1447676127
Name:DEBERNARDO, ROBERT LOUIS SR (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LOUIS
Last Name:DEBERNARDO
Suffix:SR
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ESSEX LN
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-1005
Mailing Address - Country:US
Mailing Address - Phone:203-522-7249
Mailing Address - Fax:
Practice Address - Street 1:15 ESSEX LN
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-1005
Practice Address - Country:US
Practice Address - Phone:203-522-7249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT015004207KA0200X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy