Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 000943 | CT |
NPI | 1023026010 |
---|---|
Provider Name | Mrs. Debra Ann Vinick |
First Address | Vernon, CT 06066-4838 |
Second Address | Vernon, CT 06066 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 24/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000943 | CONNECTICARE (01) | |
290000943CT01 | ANTHEM BLUE SHIELD (01) | |
P2139469 | OXFORD HEALTH PLAN (01) | |
S99907 | (02) |