Healthcare Provider Details

I. General information

NPI: 1689944811
Provider Name (Legal Business Name): NANTUCKET DERMATOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4.5 BARTLETT RD
NANTUCKET MA
02554
US

IV. Provider business mailing address

5 FEDERAL ST UNIT 1881
NANTUCKET MA
02554-1703
US

V. Phone/Fax

Practice location:
  • Phone: 781-398-2225
  • Fax: 781-398-2221
Mailing address:
  • Phone: 781-398-2225
  • Fax: 781-398-2221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: ABRAR A QURESHI
Title or Position: DIRECTOR
Credential: MD, MPH
Phone: 781-398-2225