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General NPI Number Information
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NPI Number | 1952897704
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Entity Type | Organization
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Legal Business Name | INTEGRATED DERMATOLOGY OF BRIDGEPORT, PLLC
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Dates
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Enumeration Date | 07/05/2018
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Last Update Date | 01/15/2019
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Provider Practice Location Address
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Address Line | 4639 MAIN ST
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City | BRIDGEPORT
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State | CT
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Zip | 06606-1832
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Country | US
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Telephone | 203-374-5546
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Fax | 203-371-4056
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Provider Business Mailing Address
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Address Line | 4700 EXCHANGE CT STE 110
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City | BOCA RATON
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State | FL
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Zip | 33431-4450
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Country | US
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Telephone | 561-314-2000
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Fax | 561-431-2821
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Authorized Official
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Title or Position | AUTHORIZED GROUP OFFICIAL
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Name | ADAM S. PLOTKIN
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Credential | MD
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Telephone | 561-314-2000
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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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