NPIMap

Organization Active NPI

Coastal Dermatology, P.C.

  • Dermatology Physician
  • Mystic, CT
National Provider Identifier
1992890362
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
035895 Issued in 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
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Daniella Duke, M.D.NPI 1174594279
Title
President
Phone
(860) 245-0000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 035895 CT Primary

Addresses

Primary practice location

55 Willow Street
Mystic, CT 06355

Mailing address

55 Willow Street
Mystic, CT 06355
Phone (860) 245-0000

National Provider Directory

National Provider Directory

Locations

55 Willow St
Mystic, CT 06355
Phone (860) 245-0000

Practitioners & affiliated clinicians

Practitioners 2

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": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1992890362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 WILLOW STREET",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "06355",
            "telephone_number": "860-245-0000",
            "fax_number": "860-245-0610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 WILLOW STREET",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "06355",
            "telephone_number": "860-245-0000",
            "fax_number": "860-245-0610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL DERMATOLOGY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DUKE",
        "authorized_official_first_name": "DANIELLA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "860-245-0000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "CT",
            "license": "035895",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mystic, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.