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General NPI Number Information
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NPI Number | 1164693289
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Entity Type | Organization
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Legal Business Name | ADAMS STREET DERMATOLOGY ASSOC, PC
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Dates
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Enumeration Date | 03/17/2008
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Last Update Date | 03/17/2008
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Provider Practice Location Address
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Address Line | 36 ADAMS ST
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City | QUINCY
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State | MA
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Zip | 02169-2002
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Country | US
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Telephone | 617-773-9805
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Fax |
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Provider Business Mailing Address
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Address Line | 6 ADAMS STREET
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City | QUINCY
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State | MA
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Zip | 02169-2002
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Country | US
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Telephone | 617-773-9805
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELISE B MCCARTHY
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Credential | MD
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Telephone | 617-773-9805
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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 | 81161
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License Number State | MA
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