Organization
ADVANCED DERMATOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HOWARD W. ROGERS MD (OWNER)
(860) 859-2262
Entity
Organization
Contact information
Practice address
111 SALEM TPKE, SUITE 7, NORWICH, CT 06360-6459
(860) 859-2262
(860) 859-9819
Mailing address
111 SALEM TPKE, SUITE 7, NORWICH, CT 06360-6459
(860) 859-2262
(860) 859-9819
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
002932
CT
207N00000X
Dermatology Physician
Primary
038560
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004182680
—
CT
01
—
222316481
BCBS
CT
01
—
DB9913
MEDICARE RAILROAD
CT
Enumeration date
07/15/2006
Last updated
08/18/2008
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