Healthcare Provider Details

I. General information

NPI: 1811499064
Provider Name (Legal Business Name): DERMDIAGNOSTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 03/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 SOUTH ST
PITTSFIELD MA
01201-8228
US

IV. Provider business mailing address

PO BOX 2183
LENOX MA
01240-5183
US

V. Phone/Fax

Practice location:
  • Phone: 413-496-9272
  • Fax:
Mailing address:
  • Phone: 413-441-8765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number76190
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number76190
License Number StateMA

VIII. Authorized Official

Name: DANIEL CARTER
Title or Position: PRESIDENT
Credential: MD
Phone: 413-441-8765