Middlesex Dermatology, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

16529 Issued in CT

Legal business name

MIDDLESEX DERMATOLOGY, LLC

Practice address

11 S Main St
Middletown, CT 06457-3656

Phone

(860) 347-4555

NPI assigned

Jan 19, 2017

Organization subpart

No

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

Authorized official

Name

Eric Thomas, M.D.NPI 1649290289

Title

Physician Owner

Phone

(860) 347-4555

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 3

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

• Eric Joseph Thomas, M.D.

  • Procedural Dermatology Physician
  • Middletown, CT
  • NPI 1649290289
  Medicare reassignment Care Compare group Authorized official
• Brooklyn Larisa Mickolyzck, DNP, FNP-BC

  • Family Nurse Practitioner
  • Middletown, CT
  • NPI 1376226613
  Medicare reassignment Care Compare group NPD
• Kimberly Ellen Boldon, NP-C

  • Nurse Practitioner
  • Middletown, CT
  • NPI 1083083638
  Medicare reassignment

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

{
    "created_epoch": "1484784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484784000000",
    "number": "1376089003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 S MAIN ST",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064573656",
            "telephone_number": "860-347-4555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 S MAIN ST",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064573656",
            "telephone_number": "860-347-4555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDDLESEX DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-19",
        "last_updated": "2017-01-19",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "860-347-4555",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "CT",
            "license": "16529",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mid State MD, LLC
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• Middlesex Dental Care, LLC
• Middlesex Diabetes & Endocrinology
• Middlesex Dialysis Center LLC
• Middlesex Endoscopy Center LLC
• Middlesex Eye Physicians P.C.
• Middlesex Eye Physicians, P.C.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.