Provider Demographics
NPI:1023026010
Name:VINICK, DEBRA ANN (PAC)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:ANN
Last Name:VINICK
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 HARTFORD TPKE
Mailing Address - Street 2:NEW ENGLAND DERMATOLOGY ASSOCIATES
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4838
Mailing Address - Country:US
Mailing Address - Phone:860-871-9441
Mailing Address - Fax:860-871-0227
Practice Address - Street 1:357 HARTFORD TURNPIKE
Practice Address - Street 2:NEW ENGLAND DERMATOLOGY ASSOCIATES
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066
Practice Address - Country:US
Practice Address - Phone:860-871-9441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000943207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000943OtherCONNECTICARE
290000943CT01OtherANTHEM BLUE SHIELD
P2139469OtherOXFORD HEALTH PLAN
S99907Medicare UPIN