Healthcare Provider Details

I. General information

NPI: 1326166596
Provider Name (Legal Business Name): NEWTON WELLESLEY DERMATOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 05/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 WALNUT ST SUITE 520
WELLESLEY MA
02481-2118
US

IV. Provider business mailing address

65 WALNUT ST SUITE 520
WELLESLEY MA
02481-2118
US

V. Phone/Fax

Practice location:
  • Phone: 781-237-3500
  • Fax: 781-237-7867
Mailing address:
  • Phone: 781-237-3500
  • Fax: 781-237-7867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number75461
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number58820
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2027
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1800
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number238807
License Number StateMA
# 6
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number157066
License Number StateMA

VIII. Authorized Official

Name: DR. DAVID AGHASSI
Title or Position: PHYSICIAN
Credential: MD
Phone: 781-237-3500