NPIMap

Organization Active NPI

Advanced Dermatology LLC

  • Dermatology Physician
  • Norwich, CT
National Provider Identifier
1609892298
Registry record updated Aug 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
038560 Issued in CT
Legal business name
ADVANCED DERMATOLOGY LLC
Practice address
111 Salem Tpke
Suite 7
Norwich, CT 06360-6459
Phone
(860) 859-2262
Fax
(860) 859-9819
NPI assigned
Jul 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2008

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

Authorized official

Name
Dr. Howard W. Rogers, MDNPI 1861465973
Title
Owner
Phone
(860) 859-2262

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163W00000X 002932 CT
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X 038560 CT Primary

Addresses

Primary practice location

111 Salem Tpke
Suite 7
Norwich, CT 06360-6459

Mailing address

111 Salem Tpke
Suite 7
Norwich, CT 06360-6459
Phone (860) 859-2262

Other identifiers 3

IdentifierTypeStateIssuer
DB9913OtherCTMEDICARE RAILROAD
222316481OtherCTBCBS
004182680MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040520000408 CT Part B Supplier - Clinic/Group Practice 5092706945 Receives reassigned benefits from 11 practitioners
Practice locations: Guilford, CT; Norwich, CT

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
07D0987568Advanced Dermatology111 Salem Tpke, Ste 7, Norwich, CT 06360ComplianceJun 24, 2027

National Provider Directory

National Provider Directory

Locations

139 S Main St
Colchester, CT 06415

5 Durham Rd
Ste B2
Guilford, CT 06437
Phone 203787616110

111 Salem Tpke
Ste 7
Norwich, CT 06360
Phone (860) 859-2262

Practitioners & affiliated clinicians

Practitioners 11

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

NPI Registry JSON

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219017600000",
    "number": "1609892298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 SALEM TPKE",
            "address_2": "SUITE 7",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063606459",
            "telephone_number": "860-859-2262",
            "fax_number": "860-859-9819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 SALEM TPKE",
            "address_2": "SUITE 7",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063606459",
            "telephone_number": "860-859-2262",
            "fax_number": "860-859-9819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2008-08-18",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "HOWARD",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-859-2262",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": "CT",
            "license": "002932",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "CT",
            "license": "038560",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DB9913",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "222316481",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004182680",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norwich, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2008; 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.