Organization
DERMATOLOGY ASSOCIATES OF SOUTHEASTERN CONNECTICUT, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN CHRISTOPHER WILES M.D. (PRESIDENT)
(806) 442-1346
Entity
Organization
Contact information
Practice address
425 MONTAUK AVE, NEW LONDON, CT 06320-4642
(860) 442-1346
(860) 444-6208
Mailing address
425 MONTAUK AVE, NEW LONDON, CT 06320-4642
(860) 442-1346
(860) 444-6208
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4090841
—
CT
Enumeration date
12/28/2006
Last updated
08/22/2020
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