Provider Demographics
NPI:1851464564
Name:DERMATOLOGY ASSOCIATES OF FAIRFIELD COUNTY PC
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF FAIRFIELD COUNTY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DERMATOLOGY ASSOCIATES OF
Authorized Official - Prefix:
Authorized Official - First Name:LEON
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:LUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-227-0837
Mailing Address - Street 1:191 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880
Mailing Address - Country:US
Mailing Address - Phone:203-227-0837
Mailing Address - Fax:203-227-4998
Practice Address - Street 1:191 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880
Practice Address - Country:US
Practice Address - Phone:203-227-0837
Practice Address - Fax:203-227-4998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
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
D02376Medicare UPIN