KELLY L DODGE MD (Credential# 563857) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is August 1, 2016. The license expiration date date is July 31, 2017. The license status is INACTIVE.
KELLY L DODGE MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.046275. The credential type is physician/surgeon. The effective date is August 1, 2016. The expiration date is July 31, 2017. The business address is 88 Harborside Dr, Milford, CT 06460-4825. The current status is inactive.
| Licensee Name | KELLY L DODGE MD |
| Credential ID | 563857 |
| Credential Number | 1.046275 |
| Credential Type | Physician/Surgeon |
| Business Address |
88 Harborside Dr Milford CT 06460-4825 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
| Issue Date | 2008-03-05 |
| Effective Date | 2016-08-01 |
| Expiration Date | 2017-07-31 |
| Refresh Date | 2017-11-03 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 380001 | CSP.0035812 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2004-09-02 | 2015-03-01 - 2017-02-28 | INACTIVE |
| 380058 | CSP.0035846 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2004-08-30 | 2004-08-30 - 2005-02-28 | INACTIVE |
| Street Address | 88 HARBORSIDE DR |
| City | MILFORD |
| State | CT |
| Zip Code | 06460-4825 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Claudia L Auerbach Aprn | 88 Harborside Dr, Milford, CT 06460-4825 | Advanced Practice Registered Nurse | 2020-09-01 ~ 2021-08-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Julie C Fracker | 50 Harborside Dr, Milford, CT 06460-4825 | Speech and Language Pathologist | 2020-02-01 ~ 2021-01-31 |
| John P Gerrity Jr | 50 Harborside Dr, Milford, CT 06460-4825 | Speech and Language Pathologist | 2019-07-01 ~ 2020-06-30 |
| Christopher J Fracker | 50 Harborside Dr, Milford, CT 06460-4825 | Emergency Medical Responder | 2014-08-05 ~ 2017-04-01 |
| James Fracker Construction LLC | 50 Harborside Dr, Milford, CT 06460-4825 | New Home Construction Contractor | 2018-11-15 ~ |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Milford Council On Aging | 9 Jepson Drive, Milford, CT 06460 | Public Charity | 2019-06-01 ~ 2020-05-31 |
| James J Melanson | 319 Welch's Point Road, Milford, CT 06460 | Optician | 2020-08-01 ~ 2021-07-31 |
| Robert J Colum | 61 Melba St, Milford, CT 06460 | Professional Engineer | 2020-06-16 ~ 2021-01-31 |
| James E Phillips | 88 Noble Ave, Milford, CT 06460 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Douglas H Gruber | 33 Lincoln Ave, Milford, CT 06460 | Licensed Alcohol and Drug Counselor | 2020-06-01 ~ 2021-05-31 |
| Christine D Rettig | 1 Schooner Lane, Milford, CT 06460 | Physical Therapist | 2020-07-01 ~ 2021-06-30 |
| Golden Dragon Inc | 262 D Quarry Rd, Mildord, CT 06460 | Food Warehouse | ~ |
| Kelli-ann Armstrong | 50 Cherry Street, Milford, CT 06460 | Optometrist | 2020-07-01 ~ 2021-06-30 |
| Mary C Cohen | 9 Stevens Street, Milford, CT 06460 | Notary Public Appointment | 2020-07-01 ~ 2025-06-30 |
| Nicole Wilson | 26 Daggett Street, Milford, CT 06460 | Hairdresser/cosmetician | 2020-08-01 ~ 2022-07-31 |
| Find all Licenses in zip 06460 | |||
| City | MILFORD |
| Zip Code | 06460 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + MILFORD |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Jessica L Dodge | 16 Lily Dr, Danbury, CT 06811-3281 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| John H Dodge | 2211 Congress St, Portland, ME 04122 | Physician/surgeon | 1994-09-01 ~ 1995-10-31 |
| Samuel Peleg Barasch | 2 Dodge St, Poughquag, NY 12570-5220 | Physician/surgeon | 2019-08-01 ~ 2020-08-31 |
| Vandana Gambhir | 3050 12th Ave N, Fort Dodge, IA 50501 | Physician/surgeon | ~ |
| Kelly J Dodge | 707 South St, Webster City, IA 50595-3051 | Registered Nurse | 2015-05-01 ~ 2016-05-31 |
| Sherry L Lee | 24 Kelly Dr, Marlton, NJ 08053-9701 | Physician/surgeon | 2017-07-25 ~ 2018-04-30 |
| Michael J Kelly | Po Box 585, Salisbury, CT 06068-0585 | Physician/surgeon | 2019-09-01 ~ 2020-08-31 |
| Kelly Benabou | 267 Grant St, Bridgeport, CT 06610-2805 | Physician/surgeon | ~ |
| Kelly Maureen Dillman | 342 E 110th St Apt 5d, New York, NY 10029-7088 | Physician/surgeon | ~ |
| George P Kelly | 113 Sky Top Drive, Fairfield, CT 06825 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
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| 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).