Essex Dermatology LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

ESSEX DERMATOLOGY LLC

Practice address

20 Saybrook Road
Essex, CT 06426-1401

Phone

(860) 767-9998

Fax

(860) 767-9161

NPI assigned

Dec 5, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Virginia L Maher Wiese, MDNPI 1396700217

Title

Owner

Phone

(860) 767-9998

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Virginia L Maher Wiese, MD

  • Dermatology Physician
  • Essex, CT
  • NPI 1396700217
  Medicare reassignment Care Compare group NPD Authorized official
• Elizabeth Ann Coric, MD

  • Internal Medicine Physician
  • Essex, CT
  • NPI 1730122003
  Medicare reassignment Care Compare group NPD
• Madison Taylor Mizenko, APRN, AGNP-C

  • Adult Health Nurse Practitioner
  • Essex, CT
  • NPI 1558147405
  Medicare reassignment Care Compare group NPD
• Lynn M Smith, APRN

  • Adult Health Nurse Practitioner
  • Essex, CT
  • NPI 1720333487

  Dermatology

  Medicare reassignment Care Compare group NPD
• Donna Baldwin Colquhoun, A.P.R.N.

  • Family Nurse Practitioner
  • Madison, CT
  • NPI 1548457260
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352937600000",
    "number": "1043378508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 SAYBROOK ROAD",
            "city": "ESSEX",
            "state": "CT",
            "postal_code": "064261401",
            "telephone_number": "860-767-9998",
            "fax_number": "860-767-9161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 SAYBROOK ROAD",
            "city": "ESSEX",
            "state": "CT",
            "postal_code": "064261401",
            "telephone_number": "860-767-9998",
            "fax_number": "860-767-9161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESSEX DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2012-11-15",
        "status": "A",
        "authorized_official_last_name": "MAHER WIESE",
        "authorized_official_first_name": "VIRGINIA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-767-9998",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID - GROUP",
            "identifier": "C03091",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Renee F Dunn, MSW
• Juan David Duque, PT, DPT
• Cynthia L Dvorsky, MPT
• Robert D Dwyer, MD
• Morgan Ehrler, MSW
• Essex Family Dentistry, LLC
• Essex Meadows LLC
• Essex Meadows Properties, Inc.
• Sarah Faucher
• Brian David Fay, MSW LCSW

• Dermatology Physician in Essex, CT
• Providers in Essex, CT by specialty
• Dermatology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.