NPIMap

Organization Active NPI

Dermatology Associates of Glastonbury LLC

  • Dermatology Physician
  • Glastonbury, CT
National Provider Identifier
1730175845
Registry record updated Apr 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
DERMATOLOGY ASSOCIATES OF GLASTONBURY LLC
Practice address
210 New London Tpke
Glastonbury, CT 06033-2235
Phone
(860) 633-1543
Fax
(860) 659-9755
NPI assigned
Sep 23, 2005
Last updated
Apr 7, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2021

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

Authorized official

Name
Janelle Manton, MDNPI 1841267986
Title
Partner
Phone
(860) 633-1543

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

210 New London Tpke
Glastonbury, CT 06033-2235

Mailing address

210 New London Tpke
Glastonbury, CT 06033-2235
Phone (860) 633-1543

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jmanton@dagdermdocs.ezderm.info

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040323001033 CT Part B Supplier - Clinic/Group Practice 2769373372 Receives reassigned benefits from 5 practitioners
Practice locations: Glastonbury, CT

National Provider Directory

National Provider Directory

Locations

210 New London Tpke
Glastonbury, CT 06033
Phone (860) 633-1543

Interoperability endpoints

  • Direct secure messaging: jmanton@dagdermdocs.ezderm.info

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1127433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617753600000",
    "number": "1730175845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 NEW LONDON TPKE",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060332235",
            "telephone_number": "860-633-1543",
            "fax_number": "860-659-9755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 NEW LONDON TPKE",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060332235",
            "telephone_number": "860-633-1543",
            "fax_number": "860-659-9755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY ASSOCIATES OF GLASTONBURY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-23",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A",
        "authorized_official_last_name": "MANTON",
        "authorized_official_first_name": "JANELLE",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "860-633-1543",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmanton@dagdermdocs.ezderm.info",
            "affiliation": "N",
            "address_1": "210 New London Tpke",
            "city": "Glastonbury",
            "state": "CT",
            "country_code": "US",
            "postal_code": "060332235",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Glastonbury, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.