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General NPI Number Information
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NPI Number | 1528275773
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Entity Type | Organization
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Legal Business Name | ADULT & PEDIATRIC DERMATOLOGY SPECIALISTS, P.C.
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 11/14/2008
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Provider Practice Location Address
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Address Line | 162 KINGS HWY N
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City | WESTPORT
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State | CT
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Zip | 06880-2425
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Country | US
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Telephone | 203-222-0198
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Fax |
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Provider Business Mailing Address
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Address Line | 162 KINGS HWY N
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City | WESTPORT
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State | CT
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Zip | 06880-2444
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Country | US
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Telephone | 203-222-0198
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Fax |
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Authorized Official
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Title or Position | PRACTICING ADMINISTRATOR
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Name | CINDY PETERSON
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Credential |
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Telephone | 203-377-0639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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