Healthcare Provider Details

I. General information

NPI: 1508061839
Provider Name (Legal Business Name): NORTHEAST DERMATOLOGY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 HAMPTON RD
EXETER NH
03833-4807
US

IV. Provider business mailing address

280 MERRIMACK ST STE 311
LAWRENCE MA
01843-1779
US

V. Phone/Fax

Practice location:
  • Phone: 978-470-1973
  • Fax: 978-470-1722
Mailing address:
  • Phone: 978-691-5690
  • Fax: 978-691-5693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. JEREMY P FINKLE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 978-691-5690