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General NPI Number Information
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NPI Number | 1669126546
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Entity Type | Organization
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Legal Business Name | HILLSIDE DERMATOLOGY PC
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Dates
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Enumeration Date | 02/09/2022
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 200 SILVER ST UNIT 106
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City | AGAWAM
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State | MA
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Zip | 01001-3067
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Country | US
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Telephone | 413-341-5350
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Fax | 413-341-5335
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Provider Business Mailing Address
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Address Line | 200 SILVER ST UNIT 106
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City | AGAWAM
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State | MA
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Zip | 01001-3067
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Country | US
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Telephone | 413-341-5350
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Fax | 413-341-5335
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Authorized Official
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Title or Position | MANAGER
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Name | SAVANNA SUE DYER
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Credential |
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Telephone | 413-341-5350
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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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