Randall R Dwenger, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

183297 Issued in NY

Practice address

187 S Canaan Rd
Canaan, CT 06018-2544

Phone

(860) 824-1397

Fax

(888) 690-2727

NPI assigned

Jul 22, 2006

Last updated

Jun 4, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Previously, effective Sep 12, 2018 through Sep 12, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Marjorie a. Arni LLC

  • Community/Behavioral Health Agency
  • Lakeville, CT
  • NPI 1609106558
  NPD (past)
• Michael J. Kelly MD

  • Internal Medicine Physician
  • Lakeville, CT
  • NPI 1376703751
  NPD (past)
• Northwest Center for Family Service and Mental Health, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Lakeville, CT
  • NPI 1295773844
  NPD (past)

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622764800000",
    "number": "1649291980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 CEDAR CREST",
            "address_2": "PO BOX 443",
            "city": "SALISBURY",
            "state": "CT",
            "postal_code": "060680443",
            "telephone_number": "917-513-7438",
            "fax_number": "888-690-2727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "187 S CANAAN RD",
            "city": "CANAAN",
            "state": "CT",
            "postal_code": "060182544",
            "telephone_number": "860-824-1397",
            "fax_number": "888-690-2727"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "423 E 23rd St",
            "address_2": "Room 2707",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100105011",
            "country_code": "US",
            "telephone_number": "212-686-7500 x7598",
            "fax_number": "212-951-3356",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DWENGER",
        "first_name": "RANDALL",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-22",
        "last_updated": "2021-06-04",
        "certification_date": "2021-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "183297",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dennis Kobylarz MD PC
• Garrett Thomas Deutermann, LADC
• Ashleigh Dilaurenzio, M.A., CF-SLP
• Rita-Marie Doyle-Staino, RPH
• Melissa Dube
• Laura D Ebling, PHD
• Lobna Elsarafy, PT
• Evolving Tree Therapy LLC
• Zachary Farrell
• Kathryn Fitzgerald, LPC

• Psychiatry Physician in Canaan, CT
• Providers in Canaan, CT by specialty
• Psychiatry Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.