Healthcare Provider Details

I. General information

NPI: 1356538078
Provider Name (Legal Business Name): NEW ENGLAND DERMATOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 LYME RD STE 304
HANOVER NH
03755-1223
US

IV. Provider business mailing address

PO BOX 6
HANOVER NH
03755-0006
US

V. Phone/Fax

Practice location:
  • Phone: 603-643-9700
  • Fax: 802-649-7092
Mailing address:
  • Phone: 603-643-9700
  • Fax: 802-649-7092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number042-0011909
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL ERIC MCGINLEY-SMITH
Title or Position: PHYSICIAN/MEMBER
Credential: M.D.
Phone: 603-398-2259