Healthcare Provider Details

I. General information

NPI: 1902345861
Provider Name (Legal Business Name): NEDA AT NORTH SHORE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WIDGER ROAD
MARBLEHEAD MA
01945
US

IV. Provider business mailing address

280 MERRIMACK ST SUITE 311
LAWRENCE MA
01843-1779
US

V. Phone/Fax

Practice location:
  • Phone: 978-691-5690
  • Fax: 978-691-5693
Mailing address:
  • Phone: 978-691-5690
  • Fax: 978-691-5693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JANELLE GORFINKLE
Title or Position: CREDENTIALING
Credential:
Phone: 978-691-5690