Healthcare Provider Details

I. General information

NPI: 1154982833
Provider Name (Legal Business Name): ESSENTIAL DERMATOLOGY NWH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N MAIN ST STE 201
NATICK MA
01760-1100
US

IV. Provider business mailing address

220 N MAIN ST STE 201
NATICK MA
01760-1100
US

V. Phone/Fax

Practice location:
  • Phone: 508-827-2615
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHAEL SCOTT KRATHEN
Title or Position: OWNER/MANAGER
Credential: MD
Phone: 781-431-0060