Healthcare Provider Details

I. General information

NPI: 1104217686
Provider Name (Legal Business Name): DERMATOLOGY SERVICES ND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 ROCK ODUNDEE RD
S DARTMOUTH MA
02748-1428
US

IV. Provider business mailing address

145 FAUNCE CORNER MALL RD
N DARTMOUTH MA
02747-6216
US

V. Phone/Fax

Practice location:
  • Phone: 508-990-8199
  • 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: NINA BLUMENTHAL
Title or Position: OWNER
Credential: MD
Phone: 508-993-7601