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General NPI Number Information
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NPI Number | 1588859946
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY SURGICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 499 FARMINGTON AVE SUITE 230
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City | FARMINGTON
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State | CT
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Zip | 06032-1933
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Country | US
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Telephone | 860-676-1900
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Fax | 860-409-0602
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Provider Business Mailing Address
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Address Line | 499 FARMINGTON AVE SUITE 230
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City | FARMINGTON
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State | CT
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Zip | 06032-1933
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Country | US
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Telephone | 860-676-1900
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Fax | 860-409-0602
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. TIMOTHY KYLE CHARTIER
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Credential |
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Telephone | 860-676-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 039399
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License Number State | CT
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