Organization
DERMATOLOGY SURGICAL ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY KYLE CHARTIER (PHYSICIAN)
(860) 676-1900
Entity
Organization
Contact information
Practice address
499 FARMINGTON AVE, SUITE 230, FARMINGTON, CT 06032-1933
(860) 676-1900
(860) 409-0602
Mailing address
499 FARMINGTON AVE, SUITE 230, FARMINGTON, CT 06032-1933
(860) 676-1900
(860) 409-0602
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
039399
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010039399CT02
ANTHEM BLUE CROSS/BLUE SH
CT
01
—
039399
CONNECTICARE
CT
01
—
2000464
UNITED HEALTH CARE
CT
01
—
2V5362
HEALTH NET
CT
01
—
3672726
AETNA
CT
01
—
9835320
CIGNA
CT
01
—
C03194
MEDICARE GROUP NUMBER
CT
01
—
P2392298
OXFORD
CT
Enumeration date
09/10/2007
Last updated
11/23/2011
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