Kenneth J. Maiocco, M.D., P.C.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

013652 Issued in CT

Legal business name

KENNETH J. MAIOCCO, M.D., P.C.

Practice address

4639 Main St
Bridgeport, CT 06606-1838

Phone

(203) 374-5546

Fax

(302) 371-4056

NPI assigned

Aug 22, 2007

Organization subpart

No

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

Authorized official

Name

Mr. David K. Maiocco

Title

Practice Administrator

Phone

(203) 374-5130

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1187740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187740800000",
    "number": "1487847570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4639 MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066061838",
            "telephone_number": "203-374-5546",
            "fax_number": "302-371-4056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4639 MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066061838",
            "telephone_number": "203-374-5546",
            "fax_number": "302-371-4056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH J. MAIOCCO, M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-22",
        "last_updated": "2007-08-22",
        "status": "A",
        "authorized_official_last_name": "MAIOCCO",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "203-374-5130",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "CT",
            "license": "013652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natalia Kembaren, BCBA
• Andrew S Kenler, M.D.
• Freda C Kennedy, M.D.
• Kevin Michael Kennedy, D.D.S.
• Pamela Kennedy, RDH
• Laura Kenny
• Shawna Marie Kettyle, M.D.
• Abdul Rahim Khan, MD
• Jenifer Khan, MD
• Saima A Khan, DDS

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.