MEDICARE: BEATRICE M DIAS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	044520	CT
2	207N00000X	Dermatology Physician	189168	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	044520	OTHER	CT	CT LICENSE

General Provider Information

NPI Number	:	1326009473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEATRICE M DIAS MD

Provider Business Mailing Address
First Line	:	409 BANTAM RD # A-2
Second Line	:
City	:	LITCHFIELD
State	:	CT
Zip	:	06759-3200
Country	:	US
Telephone Number	:	917-494-5777
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 BANTAM RD # A-2
Second Line	:
City	:	LITCHFIELD
State	:	CT
Zip	:	06759-3200
Country	:	US
Telephone Number	:	860-361-9660
Fax Number	:	860-361-9659

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	06/30/2008

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