Healthcare Provider Details

I. General information

NPI: 1891609277
Provider Name (Legal Business Name): INTEGRATED DERMATOLOGY MASSACHUSETTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 BEACON ST STE 1E
BROOKLINE MA
02446-5587
US

IV. Provider business mailing address

4700 EXCHANGE CT STE 110
BOCA RATON FL
33431-4450
US

V. Phone/Fax

Practice location:
  • Phone: 617-731-2390
  • Fax: 617-731-1283
Mailing address:
  • Phone: 561-948-0291
  • Fax: 561-859-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JENNIFER MORGAN
Title or Position: CFO
Credential:
Phone: 561-223-8081