Healthcare Provider Details

I. General information

NPI: 1346260866
Provider Name (Legal Business Name): PARK DERMATOLOGY ASSOC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 MAIN ST
SOUTH WEYMOUTH MA
02190
US

IV. Provider business mailing address

851 MAIN ST
SOUTH WEYMOUTH MA
02190
US

V. Phone/Fax

Practice location:
  • Phone: 781-331-2250
  • Fax: 781-331-1625
Mailing address:
  • Phone: 781-331-2250
  • Fax: 781-331-1625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAY M RITT
Title or Position: PHYSICIAN
Credential: MD
Phone: 781-331-2250