Basic Information
| Provider Information | |||||||||
| NPI: | 1770776569 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DERMATOLOGY IN CLINTON, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 E MAIN ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CLINTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064132058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606696156 | ||||||||
| FaxNumber: | 8606640285 | ||||||||
| Practice Location | |||||||||
| Address1: | 8 E MAIN ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CLINTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064132058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606696156 | ||||||||
| FaxNumber: | 8606640285 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2007 | ||||||||
| LastUpdateDate: | 08/24/2007 | ||||||||
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| AuthorizedOfficialLastName: | BARRETT | ||||||||
| AuthorizedOfficialFirstName: | SHARON | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8606696156 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ND0900X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology |
No ID Information.