Healthcare Provider Details

I. General information

NPI: 1144217670
Provider Name (Legal Business Name): AMY BETH KOFF M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 ROUTE 134 UNIT 1A
SOUTH DENNIS MA
02660-3433
US

IV. Provider business mailing address

434 ROUTE 134 UNIT 1A
SOUTH DENNIS MA
02660-3433
US

V. Phone/Fax

Practice location:
  • Phone: 508-394-5556
  • Fax: 508-394-2735
Mailing address:
  • Phone: 508-394-5556
  • Fax: 508-394-2735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number80792
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: