INTEGRATED DERMATOLOGY OF BRIDGEPORT, PLLC (NPI# 1952897704) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952897704 |
| Entity Type | Organization |
| Organization Name | INTEGRATED DERMATOLOGY OF BRIDGEPORT, PLLC |
| Practice Address |
4639 Main St Bridgeport CT 06606-1832 |
| Mailing Address |
4700 Exchange Ct Ste 110 Boca Raton FL 33431-4450 |
| Practice Telephone | 2033745546 |
| Practice Fax Number | 2033714056 |
| Mailing Telephone | 5613142000 |
| Mailing Fax Number | 5614312821 |
| Enumeration Date | 2018-07-05 |
| Last Update Date | 2019-01-15 |
| Authorized Official Name | ADAM S. PLOTKIN (AUTHORIZED GROUP OFFICIAL) |
| Authorized Official Telephone | 5613142000 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Connecticut Business Registrations | INTEGRATED DERMATOLOGY OF BRIDGEPORT, PLLC | 4700 Exchange Court, Boca Raton, FL 33431 |
| Street Address |
4639 MAIN ST |
| City | BRIDGEPORT |
| State | CT |
| Zip Code | 06606-1832 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144280637 | Kenneth Joseph Maiocco | Dermatology | 4639 Main St, Bridgeport, CT 06606-1838 | 2006-03-27 |
| 1013206481 | Moss and Maiocco Md LLC | Dermatology | 4639 Main St, Bridgeport, CT 06606-1832 | 2011-04-06 |
| 1487847570 | Kenneth J. Maiocco, M.d., P.C. | Dermatology | 4639 Main St, Bridgeport, CT 06606-1838 | 2007-08-22 |
| 1063438661 | Arcadia Health Services, Inc. | Home Health | 4639 Main St, Suite 6, Bridgeport, CT 06606-1832 | 2006-07-15 |
| 1689625188 | Jeremy Ethan Moss | Dermatology | 4639 Main St, Bridgeport, CT 06606-1838 | 2006-05-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962023408 | Madeline Acquilano | Pharmacist | 2800 East Main St, Bridgeport, CT 06606 | 2020-05-06 |
| 1578192001 | Karin Alexandra Skalina | Student in an Organized Health Care Education/Training Program | 2800 Main St., Dept. of Medicine, Bridgeport, CT 06606 | 2020-04-06 |
| 1720641293 | Valeriia Klymenko | Student in an Organized Health Care Education/Training Program | 2800 Main Street, Department of Medicine, Bridgeport, CT 06606 | 2019-04-19 |
| 1821579996 | Ashley Liese | Nurse Practitioner | Cardiology Physicians of Fairfield County, 2679 Main St, Bridgeport, CT 06606 | 2018-08-27 |
| 1699261289 | Gema Estefania Giler-sacoto | Student in an Organized Health Care Education/Training Program | St. Vincent's Medical Center, 2800 Main Street, Department of Medicine, Bridgeport, CT 06606 | 2018-07-06 |
| 1114418365 | Jona Bumci | Physician Assistant | 3180 Main St Ste 304, Bridgeport, CT 06606 | 2018-05-23 |
| 1023471299 | Qmg4, LLC | Family Medicine | 4200 Main Street, Bridgeport, CT 06606 | 2016-04-04 |
| 1861867442 | Marie Dorothea Lisieski | Social Worker | 2400 Main Street, Bridgeport, CT 06606 | 2015-12-08 |
| 1548603384 | Gerald E. Hedley | Internal Medicine | 390 Charles Street Unit #101, Bridgeport, CT 06606 | 2013-04-11 |
| 1487997581 | Gerald Micalizzi, M.d., LLC | Radiology | 558 Fairview Avenue, Bridgeport, CT 06606 | 2013-03-27 |
| Find all providers in zip 06606 | ||||
| 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 |
|---|---|---|---|---|
| 1679669345 | Allen George Saoud | Dermatology | 170 Thompson Dr Ste 200, Bridgeport, WV 26330-2608 | 2006-10-04 |
| 1144280637 | Kenneth Joseph Maiocco | Dermatology | 4639 Main St, Bridgeport, CT 06606-1838 | 2006-03-27 |
| 1013206481 | Moss and Maiocco Md LLC | Dermatology | 4639 Main St, Bridgeport, CT 06606-1832 | 2011-04-06 |
| 1053553131 | Sharifeh Farasat | Dermatology | 120 Medical Park Dr, Suite 300, Bridgeport, WV 26330-9012 | 2009-04-03 |
| 1487847570 | Kenneth J. Maiocco, M.d., P.C. | Dermatology | 4639 Main St, Bridgeport, CT 06606-1838 | 2007-08-22 |
| 1790842227 | Associates In Dermatology LLC | Dermatology | 4699 Main Street, Suite 212, Bridgeport, CT 06606 | 2007-01-03 |
| 1669583589 | Central Wv Derm Assoc Inc | Dermatology | 170 Thompson Dr, Suite 200, Bridgeport, WV 26330-2608 | 2006-08-31 |
| 1770691552 | Katherine Jane Pesce | Dermatology | 4699 Main St, Suite 212, Bridgeport, CT 06606 | 2006-08-29 |
| 1548378813 | Joseph Raymond Pesce | Dermatology | 4699 Main St, Suite 212, Bridgeport, CT 06606 | 2006-08-28 |
| 1215973995 | Charles Bradley Franz | Dermatology | 120 Medical Park Dr, Suite 200, Bridgeport, WV 26330-9012 | 2006-06-21 |
| Find all providers in BRIDGEPORT | ||||
| City | BRIDGEPORT |
| Zip Code | 06606 |
Please comment or provide details below to improve the information on INTEGRATED DERMATOLOGY OF BRIDGEPORT, PLLC.
| 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.