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General NPI Number Information
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NPI Number | 1154982833
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Entity Type | Organization
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Legal Business Name | ESSENTIAL DERMATOLOGY NWH, PLLC
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Dates
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Enumeration Date | 06/24/2019
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Last Update Date | 02/03/2020
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Provider Practice Location Address
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Address Line | 220 N MAIN ST STE 201
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City | NATICK
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State | MA
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Zip | 01760-1100
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Country | US
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Telephone | 508-827-2615
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Fax |
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Provider Business Mailing Address
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Address Line | 220 N MAIN ST STE 201
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City | NATICK
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State | MA
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Zip | 01760-1100
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MICHAEL SCOTT KRATHEN
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Credential | MD
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Telephone | 781-431-0060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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