Modern Dermatology PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

049946 Issued in CT

Legal business name

MODERN DERMATOLOGY PC

Practice address

1032 Post Rd E
Westport, CT 06880

Phone

(203) 635-0770

Fax

(203) 635-0771

NPI assigned

Mar 13, 2018

Organization subpart

No

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

Authorized official

Name

Ms. Ina King

Title

Office Manager

Phone

(201) 294-5841

Specialties & licenses 1

Addresses

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 10

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

• Nina Katherine Antonov, M.D.

  • Dermatology Physician
  • Westport, CT
  • NPI 1467847582
  Medicare reassignment Care Compare group NPD
• Rhonda Quain Klein, MD

  • Dermatology Physician
  • Westport, CT
  • NPI 1033386867
  Medicare reassignment Care Compare group NPD
• Deanne Mraz, MD

  • Procedural Dermatology Physician
  • Westport, CT
  • NPI 1659542397
  Medicare reassignment Care Compare group NPD
• Marc Mahoney Beuttler

  • Dermatology Physician
  • New York, NY
  • NPI 1376030866

  CT

  Medicare reassignment Care Compare group NPD
• Donna Lam Cahill, PA

  • Physician Assistant
  • Mount Kisco, NY
  • NPI 1760244719

  CT

  Medicare reassignment Care Compare group NPD
• Shayan Cheraghlou, MD

  • Dermatology Physician
  • Bluefield, VA
  • NPI 1336760677

  CT

  Medicare reassignment Care Compare group NPD
• Devan Rae Cargnel, DNP, FNP-BC, APRN

  • Primary Care Nurse Practitioner
  • Westport, CT
  • NPI 1790512200
  NPD
• Melanie Conly

  • Physical Therapist
  • Westport, CT
  • NPI 1871543173
  NPD
• Michael K Miller, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Greenwich, CT
  • NPI 1730168394
  NPD
• Sophia Alejandra Robinson

  • Family Medicine Physician
  • North Haven, CT
  • NPI 1114736360

  Dermatology

  NPD (past)

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

{
    "created_epoch": "1520899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531872000000",
    "number": "1497258719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1032 POST RD E",
            "city": "WESTPORT",
            "state": "CT",
            "postal_code": "068805369",
            "telephone_number": "203-635-0770",
            "fax_number": "203-635-0771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1032 POST RD E",
            "city": "WESTPORT",
            "state": "CT",
            "postal_code": "06880",
            "telephone_number": "203-635-0770",
            "fax_number": "203-635-0771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DERMATOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-13",
        "last_updated": "2018-07-18",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "INA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "201-294-5841",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "CT",
            "license": "049946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mindful Psychiatry LLC (Mindful Psychiatry)
• Diana E Miner, PHD
• Sandra Mini, M.D.
• Joseph Miro
• Dean Joseph Moccia II
• Sachin Modi, M.D.
• Daniel Modlinger
• Modugno Clinical Therapy, LLC (Aspire Counseling)
• Elizabeth V. Modugno, LCSW
• Deborah Anne Mogelof, M.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2018; 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.