Healthcare Provider Details

I. General information

NPI: 1487636924
Provider Name (Legal Business Name): DERMATOLOGY ASSOCIATES OF WORCESTER COUNTY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL RD SUITE 2D
LEOMINSTER MA
01453-2253
US

IV. Provider business mailing address

100 HOSPITAL RD SUITE 2D
LEOMINSTER MA
01453-2253
US

V. Phone/Fax

Practice location:
  • Phone: 978-534-0582
  • Fax: 978-534-6519
Mailing address:
  • Phone: 978-534-0582
  • Fax: 978-534-6519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS H. CAHN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 978-534-0582