Healthcare Provider Details

I. General information

NPI: 1356457949
Provider Name (Legal Business Name): DERMATOLOGY CENTER IN THE BERKSHIRES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 MAIN ST SUITE 9
GREAT BARRINGTON MA
01230-2148
US

IV. Provider business mailing address

780 MAIN ST SUITE 9
GREAT BARRINGTON MA
01230-2148
US

V. Phone/Fax

Practice location:
  • Phone: 413-528-5184
  • Fax: 413-528-1077
Mailing address:
  • Phone: 413-528-5184
  • Fax: 413-528-1077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2077441
License Number StateMA

VIII. Authorized Official

Name: DR. SCOTT L GOFFIN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 413-528-5184