NPI 1265868558 · live from the CMS NPI Registry
Integrated Dermatology Of Groton LLC
Dermatology in Groton, CT. National Provider Identifier 1265868558, active.
NPI record
| NPI | 1265868558 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dermatology 207N00000X |
| Practice location | 481 Gold Star Hwy Ste 201, Groton, CT 06340 |
| Practice phone | 860-445-8020 |
| Mailing address | 4700 Exchange Ct Ste 110, Boca Raton, FL 33431 |
| Enumerated | September 19, 2013 |
| Last updated | January 11, 2019 |
| Authorized official | Jeffrey Queen, Manager |
| Other names | Eastern Connecticut Dermatology |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dermatology primary | 207N00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.