MEDICARE: WESTFORD DERMATOLOGY AND COSMETIC CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant
2	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1003161381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTFORD DERMATOLOGY AND COSMETIC CENTER LLC

Provider Business Mailing Address
First Line	:	506 GROTON RD
Second Line	:
City	:	WESTFORD
State	:	MA
Zip	:	01886-6326
Country	:	US
Telephone Number	:	978-399-0061
Fax Number	:	978-399-0069

Provider Business Practice Location Address
First Line	:	506 GROTON RD
Second Line	:
City	:	WESTFORD
State	:	MA
Zip	:	01886-6326
Country	:	US
Telephone Number	:	978-399-0061
Fax Number	:	978-399-0069

Authorized Official
Title or Position	:	CFO
Name	:	JOHN F OLIVIERI
Credential	:
Telephone Number	:	978-399-0061

Provider Enumeration Date	:	07/23/2012
Last Update Date	:	07/30/2025

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