Provider Demographics
NPI:1922251107
Name:DERMATOLOGY IN HAMDEN, LLC
Entity Type:Organization
Organization Name:DERMATOLOGY IN HAMDEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERLINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-677-4539
Mailing Address - Street 1:2880 OLD DIXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3144
Mailing Address - Country:US
Mailing Address - Phone:203-288-5624
Mailing Address - Fax:203-288-7782
Practice Address - Street 1:2880 OLD DIXWELL AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3144
Practice Address - Country:US
Practice Address - Phone:203-288-5624
Practice Address - Fax:203-288-7782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035147174400000X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty