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General NPI Number Information
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NPI Number | 1366805335
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Entity Type | Organization
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Legal Business Name | SOUTH SHORE SKIN CENTER
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Dates
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Enumeration Date | 03/29/2016
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 75 WASHINGTON ST
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City | NORWELL
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State | MA
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Zip | 02061-1795
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Country | US
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Telephone | 781-878-6495
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Fax | 781-878-6524
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Provider Business Mailing Address
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Address Line | 1 SCOBEE CIR UNIT 3
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City | PLYMOUTH
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State | MA
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Zip | 02360-4887
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Country | US
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Telephone | 508-747-0711
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Fax | 508-747-0011
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DR. RICHARD F EISEN
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Credential | M.D.
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Telephone | 508-747-0711
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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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