Healthcare Provider Details

I. General information

NPI: 1730339284
Provider Name (Legal Business Name): CENTRAL MASS DERMATOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2008
Last Update Date: 08/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 MAIN STREET
SOUTHBRIDGE MA
01550-2593
US

IV. Provider business mailing address

222 MAIN STREET
SOUTHBRIDGE MA
01550-2593
US

V. Phone/Fax

Practice location:
  • Phone: 508-765-7711
  • Fax: 508-765-7713
Mailing address:
  • Phone: 508-765-7711
  • Fax: 508-765-7713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number178544
License Number StateMA

VIII. Authorized Official

Name: MS. KATHRYN E SWANSON
Title or Position: OWNER
Credential: FNP
Phone: 508-765-7711