INTEGRATED DERMATOLOGY OF GROTON LLC (NPI# 1265868558) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265868558 |
| Entity Type | Organization |
| Organization Name | INTEGRATED DERMATOLOGY OF GROTON LLC |
| Other Organization Name | EASTERN CONNECTICUT DERMATOLOGY |
| Practice Address |
481 Gold Star Hwy Ste 201 Groton CT 06340-6702 |
| Mailing Address |
4700 Exchange Ct Ste 110 Boca Raton FL 33431-4450 |
| Practice Telephone | 8604458020 |
| Mailing Telephone | 5613142000 |
| Enumeration Date | 2013-09-19 |
| Last Update Date | 2019-01-11 |
| Authorized Official Name | JEFFREY D. QUEEN (MANAGER) |
| Authorized Official Telephone | 5613142000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Eastern Connecticut Dermatology | Doing Business As Name - Organization |
| Street Address |
481 GOLD STAR HWY STE 201 |
| City | GROTON |
| State | CT |
| Zip Code | 06340-6702 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912558610 | Bruce Lancel Bernardo Lara | Military Health Care Provider | Fpo, Ae, 09587-2417, Groton, AE 06340 | 2019-09-24 |
| 1295393692 | Ermelinda Elaine Alviso | Military Health Care Provider | Trout Ave, Groton, CT 06340 | 2019-05-31 |
| 1679034011 | Derek James Hale | Military Health Care Provider | Fc 83 Numi, Trout Ave, Groton, CT 06340 | 2019-03-28 |
| 1063973790 | Cody Eugene Shaw | Military Health Care Provider | Numi, Trout Ave Building 83, Groton, CT 06340 | 2019-03-26 |
| 1265906911 | Homelife Companions and Homemakers, LLC | Adult Companion | 1 Fort Hill Road, Suite 3, Groton, CT 06340 | 2019-01-16 |
| 1144735457 | Kristina Marie Carta | Behavior Technician | 220 Rt 12, Suite 205, Groton, CT 06340 | 2017-12-08 |
| 1538674262 | Tercel Dental Pllc | Dentist | 643 Gold Star Hwy., Groton, CT 06340 | 2017-12-04 |
| 1306361662 | Stonington Behavioral Health Inc | Psychologist | 618 Poquonnock Rd, Groton, CT 06340 | 2017-08-08 |
| 1104347806 | Renae Reynolds | Optometrist | 489 Gold Star Hwy Ste 100, Groton, CT 06340 | 2017-07-03 |
| 1053831552 | Susan A Bradbury | Physical Therapist | 455 Eastern Point Rd, Groton, CT 06340 | 2017-06-26 |
| Find all providers in zip 06340 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447459672 | Eric R. Wolf, M.d., P.C. | Dermatology | 495 Gold Star Hwy, Suite 108, Groton, CT 06340-6228 | 2007-07-17 |
| 1043308885 | Eric R Wolf | Dermatology | 495 Gold Star Hwy, Suite 108, Groton, CT 06340-6228 | 2006-10-10 |
| 1811950074 | Robert B. Ecker | Dermatology | 491 Gold Star Hwy, Suite 310, Groton, CT 06340 | 2006-04-10 |
| 1215908991 | Diane Meg Davidson | Dermatology | 491 Gold Star Hwy, Suite 310, Groton, CT 06340 | 2006-01-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477175966 | Young Skin | Dermatology | 1111 Summer St, Stamford, CT 06905-5508 | 2020-05-07 |
| 1922633213 | The Dermatology Center of Connecticut, LLC | Dermatology | 60 Church St Unit 4b, Wallingford, CT 06492-2340 | 2020-03-06 |
| 1063055853 | Integrated Dermatology of Vernon, Pllc | Dermatology | 357 Hartford Tpke Fl 2, Vernon, CT 06066-4838 | 2019-10-24 |
| 1023663424 | Dermatology Solutions, LLC | Dermatology | 35 E Main St Ste 118, Avon, CT 06001-3845 | 2019-08-03 |
| 1407374481 | Center for Skin Surgery & Dermatology, Pllc | Dermatology | 2928 Main St Ste 100, Glastonbury, CT 06033-1007 | 2017-08-30 |
| 1962933572 | Daniel Mark Klufas | Dermatology | 64 Tuckahoe Rd, Easton, CT 06612-2054 | 2017-03-24 |
| 1912446782 | Associates In Medical & Cosmetic Dermatology, PC | Dermatology | 9 Washington Avenue, Hamden, CT 06518 | 2017-02-14 |
| 1457728883 | Integrated Dermatology of Clinton,llc | Dermatology | 8 E Main St Ste 101, Clinton, CT 06413-2058 | 2015-09-02 |
| 1760873210 | Nicholas V Perricone | Dermatology | 639 Research Pkwy, Meriden, CT 06450-7154 | 2015-02-05 |
| 1497160535 | Dean David George | Dermatology | 399 Farmington Ave Ste 260, Farmington, CT 06032-1979 | 2014-06-27 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.