Healthcare Provider Details

I. General information

NPI: 1629260435
Provider Name (Legal Business Name): LITCHFIELD HILLS DERMATOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 BANTAM RD STE 2A
LITCHFIELD CT
06759-3200
US

IV. Provider business mailing address

409 BANTAM RD STE 2A
LITCHFIELD CT
06759-3200
US

V. Phone/Fax

Practice location:
  • Phone: 860-361-9660
  • Fax: 860-361-9659
Mailing address:
  • Phone: 860-361-9660
  • Fax: 860-361-9659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number044520
License Number StateCT

VIII. Authorized Official

Name: DR. BEATRICE MARIA DIAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 917-494-5777