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General NPI Number Information
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NPI Number | 1063279420
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Entity Type | Organization
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Legal Business Name | MARITIME MOHS PC
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Dates
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Enumeration Date | 03/04/2024
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Last Update Date | 10/19/2025
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Provider Practice Location Address
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Address Line | 62 WALNUT ST STE 1
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City | WELLESLEY HILLS
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State | MA
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Zip | 02481-2109
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Country | US
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Telephone | 617-710-6585
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Fax |
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Provider Business Mailing Address
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Address Line | 68 WELLESLEY RD
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City | BELMONT
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State | MA
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Zip | 02478-2125
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Country | US
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Telephone | 617-710-6585
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JESSICA SUZANNE MOSHER
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Credential | MD
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Telephone | 617-710-6585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NI0002X
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Taxonomy Name | Clinical & Laboratory Dermatological Immunology Physician
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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 | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #4
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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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Taxonomy #5
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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