Provider Demographics
NPI:1326009473
Name:DIAS, BEATRICE M (MD)
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:M
Last Name:DIAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 BANTAM RD # A-2
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759-3200
Mailing Address - Country:US
Mailing Address - Phone:917-494-5777
Mailing Address - Fax:
Practice Address - Street 1:409 BANTAM RD # A-2
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06759-3200
Practice Address - Country:US
Practice Address - Phone:860-361-9660
Practice Address - Fax:860-361-9659
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044520207N00000X
NY189168207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT044520OtherCT LICENSE
F32061Medicare UPIN
NY66K881Medicare PIN
NY66K882Medicare PIN