Healthcare Provider Details

I. General information

NPI: 1003161381
Provider Name (Legal Business Name): WESTFORD DERMATOLOGY AND COSMETIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 GROTON RD
WESTFORD MA
01886-6326
US

IV. Provider business mailing address

506 GROTON RD
WESTFORD MA
01886-6326
US

V. Phone/Fax

Practice location:
  • Phone: 978-399-0061
  • Fax: 978-399-0069
Mailing address:
  • Phone: 978-399-0061
  • Fax: 978-399-0069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: JOHN F OLIVIERI
Title or Position: CFO
Credential:
Phone: 978-399-0061