Healthcare Provider Details

I. General information

NPI: 1033873419
Provider Name (Legal Business Name): DERMCARE MASS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 VILLAGE SQ
CHELMSFORD MA
01824-2712
US

IV. Provider business mailing address

526 MAIN ST STE 302
ACTON MA
01720-3301
US

V. Phone/Fax

Practice location:
  • Phone: 978-244-0060
  • Fax:
Mailing address:
  • Phone: 978-371-7010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SAMUEL GOOS
Title or Position: OWNER
Credential:
Phone: 978-371-7010