Healthcare Provider Details

I. General information

NPI: 1285614834
Provider Name (Legal Business Name): ADULT & PEDIATRIC DERMATOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 10/28/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 BAKER AVENUE EXT STE 305&306
CONCORD MA
01742-2137
US

IV. Provider business mailing address

526 MAIN ST STE 302
ACTON MA
01720-3301
US

V. Phone/Fax

Practice location:
  • Phone: 978-371-7010
  • Fax: 978-371-0522
Mailing address:
  • Phone: 978-371-7010
  • Fax: 978-371-0522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. SAMUEL D GOOS
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 978-371-7010