Elizabeth A Dieckman, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

055188 Issued in CT

Practice address

2200 Whitney Ave
Suite 240
Hamden, CT 06518-3691

Phone

(203) 287-5400

Fax

(203) 281-3001

NPI assigned

May 13, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: edieckman106170@direct.ynhh.org

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

• Northeast Medical Group, Inc.

  • Internal Medicine Physician
  • Bridgeport, CT
  • NPI 1043278351

  Pediatrics

  Medicare reassignment NPD

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

{
    "created_epoch": "1368403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463702400000",
    "number": "1750727178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "226 MILL HILL AVE",
            "address_2": "3RD FLOOR",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066102826",
            "telephone_number": "203-287-5400",
            "fax_number": "203-281-3001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 WHITNEY AVE",
            "address_2": "SUITE 240",
            "city": "HAMDEN",
            "state": "CT",
            "postal_code": "065183691",
            "telephone_number": "203-287-5400",
            "fax_number": "203-281-3001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIECKMAN",
        "first_name": "ELIZABETH",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-13",
        "last_updated": "2016-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "055188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia Lynn Desmarais, PT
• Christina Devos
• Lurline Frances Devos, PH.D.
• Kdiana Tamara Diakhate, MFT
• Richard Diana, M.D.
• Toure Diggs
• Melissa Dilauro, LMT
• Marcie E Dimenstein, LCSW
• Mia Christina Dioguardi, PA-C
• Jennifer Disorbo, MS, CCC/SLP

• Pediatrics Physician in Hamden, CT
• Providers in Hamden, CT by specialty
• Pediatrics Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.