DIANE L FOUNTAS (Credential# 545025) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is May 1, 2020. The license expiration date date is April 30, 2021. The license status is ACTIVE.
DIANE L FOUNTAS is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.024436. The credential type is physician/surgeon. The effective date is May 1, 2020. The expiration date is April 30, 2021. The business address is Pediatric and Adolescent Medicine, Watertown, CT 06795. The current status is active.
| Licensee Name | DIANE L FOUNTAS |
| Credential ID | 545025 |
| Credential Number | 1.024436 |
| Credential Type | Physician/Surgeon |
| Business Address |
Pediatric and Adolescent Medicine Watertown CT 06795 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 1983-09-09 |
| Effective Date | 2020-05-01 |
| Expiration Date | 2021-04-30 |
| Refresh Date | 2020-02-10 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 151333 | CSP.0012386 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 1999-03-01 | 2019-03-01 - 2021-02-28 | ACTIVE |
| Street Address | Pediatric And Adolescent Medicine |
| City | Watertown |
| State | CT |
| Zip Code | 06795 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Taylor Mia Lundy | 265 Kimberly Ln, Watertown, CT 06795 | Registered Nurse | 2020-06-27 ~ 2020-11-30 |
| Judith A Hill | 23 Malvern Hill Road, Watertown, CT 06795 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Carol Mancini Dumond | 57 Bryant, Watertown, CT 06795 | Chiropractor | 2020-07-01 ~ 2021-06-30 |
| Michelle J Stankus | 119 Edge Road, Watertown, CT 06795 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Linda Z Terenzo · Grella | 215 Claxton Ave., Watertown, CT 06795 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Egbrid T30 Pr 9358 | 856 Echo Lake Rd, Watertown, CT 06795 | Medical Marijuana Producer Brand Registration | 2020-06-26 ~ |
| Ana L Guaman | 1278 Main Street Ste 4, Watertown, CT 06795 | Nail Technician | ~ |
| Eric A Tymula | 727 Park Rd, Watertown, CT 06795 | Tattoo Technician | 2020-03-01 ~ 2022-02-28 |
| Margaret A Chilson | 259 Litchfield Road, Watertown, CT 06795 | Massage Therapist | 2020-05-01 ~ 2022-04-30 |
| Laura L Rock | 187 Georgetown Drive, Watertown, CT 06795 | Notary Public Appointment | 2020-06-01 ~ 2025-05-31 |
| Find all Licenses in zip 06795 | |||
| City | Watertown |
| Zip Code | 06795 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + Watertown |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Diane M Aslanis Do | Hartford, CT 06105 | Physician/surgeon | 2010-05-01 ~ 2011-04-30 |
| Diane C Lorusso | 4 Flagler Dr, Rye, NY 10580-1850 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Diane Kim | 65 Katherine Ct, Shelton, CT 06484-4336 | Physician/surgeon | 2020-01-01 ~ 2020-12-31 |
| Diane K Jorkasky | 60 Manor Ave, Wellesley, MA 02482-1032 | Physician/surgeon | 2011-01-01 ~ 2011-12-31 |
| Diane W Mickley Md | 200 Pemberwick Rd Ste 12, Greenwich, CT 06831-4236 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
| Diane C Rudolph | 15 E 75th St, New York, NY 10021-2660 | Physician/surgeon | 2017-05-01 ~ 2018-04-30 |
| Diane K Hankes Do | 400 Skyloft Dr Apt 302, Asheville, NC 28801-1951 | Physician/surgeon | 2009-02-09 ~ 2009-11-30 |
| Diane D Wirz | 42 Fairmount Dr., Danbury, CT 06811 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Diane Lusas | Po Box 5290, Brookfield, CT 06804-5290 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Diane Dickinson | Po Box 1127, Arcata, CA 95518-1127 | Physician/surgeon | 2020-06-20 ~ 2020-11-30 |
Please comment or provide details below to improve the information on DIANE L FOUNTAS.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).