Provider Demographics
NPI:1790842227
Name:ASSOCIATES IN DERMATOLOGY LLC
Entity Type:Organization
Organization Name:ASSOCIATES IN DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:PESCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-372-8949
Mailing Address - Street 1:4699 MAIN STREET
Mailing Address - Street 2:SUITE 212
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606
Mailing Address - Country:US
Mailing Address - Phone:203-372-8949
Mailing Address - Fax:203-374-9296
Practice Address - Street 1:4699 MAIN STREET
Practice Address - Street 2:SUITE 212
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606
Practice Address - Country:US
Practice Address - Phone:203-372-8949
Practice Address - Fax:203-374-9296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP00281464Medicare ID - Type Unspecified
D02764Medicare UPIN