Healthcare Provider Details

I. General information

NPI: 1629808431
Provider Name (Legal Business Name): AYER DERMATOLOGY AND SURGERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 GROTON RD STE 180
AYER MA
01432-1189
US

IV. Provider business mailing address

39 E BARE HILL RD
HARVARD MA
01451-1852
US

V. Phone/Fax

Practice location:
  • Phone: 978-772-7221
  • Fax:
Mailing address:
  • Phone: 603-290-2188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE KANNLER
Title or Position: CEO
Credential: MD
Phone: 603-290-2188