MEDICARE: COLLIN DIMLER

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	363AS0400X	Surgical Physician Assistant
2	363AS0400X	Surgical Physician Assistant	004255	CT

General Provider Information

NPI Number	:	1548754310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLIN DIMLER

Provider Business Mailing Address
First Line	:	85 SEYMOUR ST STE 1003
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06106-5529
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	85 SEYMOUR ST STE 1003
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06106-5529
Country	:	US
Telephone Number	:	845-389-1232
Fax Number	:

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

Provider Enumeration Date	:	06/15/2018
Last Update Date	:	09/28/2022

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Directions to “ COLLIN DIMLER ” Practice Location

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