Paula Michele Bevilacqua, M.D.
Individual provider Active NPI Dermatology Physician · Cheshire, CT
NPI 1790715209 · NPPES record last updated Jul 25, 2007
Key facts
- NPI
- 1790715209
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dermatology Physician 207N00000X
- License
- 029901 (CT)
- Practice address
- 677 S Main St
Cheshire, CT 06410-3158 - Phone
- (203) 250-7577
- Fax
- (203) 250-0739
- NPI assigned
- Jul 3, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110120000377 | CT | Practitioner - Dermatology | 7911098165 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 029901 | CT | MD | Dermatology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 029901 | CT | Yes |
Addresses
Primary practice location
677 S Main St
Cheshire, CT 06410-3158
Mailing address
677 S Main St
Cheshire, CT 06410-3158
Phone (203) 250-7577
Other providers in Cheshire, CT
- Joshua Berez
- Alvin H Berkon
- Natalie Bernard
- Best Care at Home Services LLC
- Jessica Bevacqua
- BH Cheshire LLC
- Esha Bhardwaj
- Ira Bhatnagar
- Nicole Biatowas
- Chanon C Biceglia
All providers in Cheshire, CT · Dermatology Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 25, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.