Organization
CRV DERMATOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DARLENE MARIE HAVILAND PAC (PRESIDENT OWNER)
(860) 741-2225
Entity
Organization
Contact information
Practice address
113 ELM ST, SUITE 200, ENFIELD, CT 06082-3700
(860) 741-2225
(860) 741-2229
Mailing address
113 ELM ST, SUITE 200, ENFIELD, CT 06082-3700
(860) 741-2225
(860) 741-2229
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001494
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2051095
—
CT
05
—
9748130
—
CT
Enumeration date
03/20/2007
Last updated
08/22/2020
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