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Provider Information for 1750386462

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1750386462

Calendar   Last Updated:  2019-01-03
  Certification Date: 


Name Value
NPI 1750386462
Enumeration Date 2005-06-17
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 65 KANE ST
WEST HARTFORD, CT 06119-2110
United States

Phone: 860-523-6421 | Fax: 860-523-3021
View Map External Link
Primary Practice Address 263 FARMINGTON AVE
FARMINGTON, CT 06030-0001
United States

Phone: 860-679-4600 | Fax: 860-679-1248
View Map External Link
Secondary Practice Address 1600 SW ARCHER RD
GAINESVILLE, FL 32610-0279
United States

Phone: 352-594-1919 | Fax:
View Map External Link

Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID FL 101119600
Primary Taxonomy Selected Taxonomy State License Number
Yes 207N00000X - Dermatology CT 021687
No 207N00000X - Dermatology FL ME132882