Active NPI
Karen Dettmer, MD
- Pediatric Adolescent Medicine Physician
- Torrington, CT
National Provider Identifier
1154363430
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Adolescent Medicine Physician
- License
- 038261
- Practice address
- 20 Felicity LN
Torrington, CT 06790-6101 - Phone
- (860) 489-4144
- Fax
- (860) 489-4412
- NPI assigned
- Jun 12, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Adolescent Medicine Physician | 2080A0000X | 038261 | CT | Primary |
Addresses
Primary practice location
20 Felicity LN
Torrington, CT 06790-6101
Mailing address
20 Felicity LN
Torrington, CT 06790-6101
Phone (860) 496-0450
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001382613 | Medicaid | CT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038261 | CT | MD | Pediatric Adolescent Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393804800000",
"number": "1154363430",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 FELICITY LN",
"city": "TORRINGTON",
"state": "CT",
"postal_code": "067906101",
"telephone_number": "860-496-0450"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20 FELICITY LN",
"city": "TORRINGTON",
"state": "CT",
"postal_code": "067906101",
"telephone_number": "860-489-4144",
"fax_number": "860-489-4412"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DETTMER",
"first_name": "KAREN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-12",
"last_updated": "2014-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "2080A0000X",
"taxonomy_group": "",
"desc": "Pediatrics, Adolescent Medicine",
"state": "CT",
"license": "038261",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001382613",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Torrington, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.