Provider Demographics
NPI:1942548847
Name:DERMATOLOGY PHYSICIANS OF CONNECTICUT PC
Entity Type:Organization
Organization Name:DERMATOLOGY PHYSICIANS OF CONNECTICUT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOYD
Authorized Official - Middle Name:S
Authorized Official - Last Name:GODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-856-6373
Mailing Address - Street 1:4 CORPORATE DR
Mailing Address - Street 2:STE 386
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-6211
Mailing Address - Country:US
Mailing Address - Phone:203-856-6373
Mailing Address - Fax:203-957-3536
Practice Address - Street 1:4 CORPORATE DR
Practice Address - Street 2:STE 386
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6211
Practice Address - Country:US
Practice Address - Phone:203-856-6373
Practice Address - Fax:203-957-3536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040226174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH62871Medicare UPIN