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General NPI Number Information
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NPI Number | 1245510049
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Entity Type | Organization
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Legal Business Name | NORTHEAST DERMATOLOGY ASSOCIATES
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Dates
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Enumeration Date | 08/24/2011
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Last Update Date | 08/24/2011
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Provider Practice Location Address
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Address Line | 1 WALLACE BASHAW WAY SUITE 1002
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City | NEWBURYPORT
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State | MA
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Zip | 01950-3875
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Country | US
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Telephone | 978-691-5690
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Fax | 978-691-5693
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Provider Business Mailing Address
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Address Line | 401 ANDOVER ST SUITE 101
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City | NORTH ANDOVER
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State | MA
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Zip | 01845-5076
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Country | US
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Telephone | 978-691-5690
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Fax | 978-691-5693
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Authorized Official
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Title or Position | PRESIDENT, NORTHEAST DERMATOLOGY AS
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Name | DR. JEREMY P FINKLE
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Credential | M.D.
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Telephone | 978-691-5690
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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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