Coastal Dermatology, P.C.
Organization Active NPI Dermatology Physician · Mystic, CT
NPI 1992890362 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1992890362
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- License
- 035895 (CT)
- Legal business name
- COASTAL DERMATOLOGY, P.C.
- Practice address
- 55 Willow Street
Mystic, CT 06355 - Phone
- (860) 245-0000
- Fax
- (860) 245-0610
- NPI assigned
- Oct 3, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Daniella Duke, M.D.
- Title
- President
- Phone
- (860) 245-0000
Practitioners 1
-
Ned Jay Gross, M.D.
National Provider Directory
Locations
55 Willow St
Mystic, CT 06355
Phone (860) 245-0000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | 035895 | CT | Yes |
Addresses
Primary practice location
55 Willow Street
Mystic, CT 06355
Mailing address
55 Willow Street
Mystic, CT 06355
Phone (860) 245-0000
Other providers in Mystic, CT
- Katieanne P Christian
- Christopher Level Inc
- Kathrine Lynn Clarke
- Jeannine Cleaver
- Coastal Chiropractic & Family Wellness Centre
- Connecticut CVS Pharmacy, L.L.C.
- Celine Conti
- Continuum, LLC
- Kyle Cook
- Creative Perspectives Counseling, LLC
All providers in Mystic, 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 Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.