Healthcare Provider Details

I. General information

NPI: 1710088216
Provider Name (Legal Business Name): NORTHAMPTON DERMATOLOGY ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 NONOTUCK STREET SUITE 107
FLORENCE MA
01062
US

IV. Provider business mailing address

190 NONOTUCK STREET SUITE 107
FLORENCE MA
01062
US

V. Phone/Fax

Practice location:
  • Phone: 413-586-5798
  • Fax: 413-585-0587
Mailing address:
  • Phone: 413-586-5798
  • Fax: 413-585-0587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRUCE M. GOLDSTEIN
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 413-586-5798