Dermatology Surgical Associates, LLC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

039399 Issued in CT

Legal business name

DERMATOLOGY SURGICAL ASSOCIATES, LLC

Practice address

499 Farmington Ave
Suite 230
Farmington, CT 06032-1933

Phone

(860) 676-1900

Fax

(860) 409-0602

NPI assigned

Sep 10, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Timothy Kyle Chartier

Title

Physician

Phone

(860) 676-1900

Specialties & licenses 1

Addresses

Other identifiers 8

Locations

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

{
    "created_epoch": "1189382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322006400000",
    "number": "1588859946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "499 FARMINGTON AVE",
            "address_2": "SUITE 230",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060321933",
            "telephone_number": "860-676-1900",
            "fax_number": "860-409-0602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "499 FARMINGTON AVE",
            "address_2": "SUITE 230",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060321933",
            "telephone_number": "860-676-1900",
            "fax_number": "860-409-0602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY SURGICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-10",
        "last_updated": "2011-11-23",
        "status": "A",
        "authorized_official_last_name": "CHARTIER",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "KYLE",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "860-676-1900",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "CT",
            "license": "039399",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "9835320",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "2V5362",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICARE",
            "identifier": "039399",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "2000464",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "C03194",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P2392298",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "3672726",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS/BLUE SH",
            "identifier": "010039399CT02",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• MOHS-Micrographic Surgery Physician in Farmington, CT
• Providers in Farmington, CT by specialty
• MOHS-Micrographic Surgery Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2011; 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.