Organization
EASTERN CONNECTICUT DERMATOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIANE M DAVIDSON M.D. (OWNER)
(860) 445-8020
Entity
Organization
Contact information
Practice address
491 GOLD STAR HWY, SUITE 310, GROTON, CT 06340-6226
(860) 445-8020
(860) 445-1665
Mailing address
491 GOLD STAR HWY, SUITE 310, GROTON, CT 06340-6226
(860) 445-8020
(860) 445-1665
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
025536
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001233204
—
CT
05
—
001255363
—
CT
Enumeration date
05/03/2007
Last updated
11/25/2013
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