Organization
DERMATOLOGY ASSOCIATES OF WTBY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SALVATORE V ROMANO MD (VICE PRESIDENT)
(203) 757-8919
Entity
Organization
Contact information
Practice address
171 GRANDVIEW AVE, SUITE 103, WATERBURY, CT 06708-2517
(203) 757-8919
(203) 756-4697
Mailing address
171 GRANDVIEW AVE, SUITE 103, WATERBURY, CT 06708-2517
(203) 757-8919
(203) 756-4697
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004001756
—
CT
01
—
070000151
MEDICARE GROUP #
CT
01
—
07D0100073
BLUE CROSS NUMBER CLIA
—
Enumeration date
09/06/2006
Last updated
06/21/2018
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