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General NPI Number Information
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NPI Number | 1003161381
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Entity Type | Organization
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Legal Business Name | WESTFORD DERMATOLOGY AND COSMETIC CENTER LLC
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Dates
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Enumeration Date | 07/23/2012
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 506 GROTON RD
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City | WESTFORD
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State | MA
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Zip | 01886-6326
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Country | US
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Telephone | 978-399-0061
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Fax | 978-399-0069
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Provider Business Mailing Address
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Address Line | 506 GROTON RD
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City | WESTFORD
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State | MA
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Zip | 01886-6326
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Country | US
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Telephone | 978-399-0061
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Fax | 978-399-0069
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Authorized Official
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Title or Position | CFO
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Name | JOHN F OLIVIERI
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Credential |
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Telephone | 978-399-0061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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