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General NPI Number Information
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NPI Number | 1689944811
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Entity Type | Organization
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Legal Business Name | NANTUCKET DERMATOLOGY, LLC
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Dates
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Enumeration Date | 01/04/2012
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 4.5 BARTLETT RD
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City | NANTUCKET
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State | MA
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Zip | 02554
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Country | US
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Telephone | 781-398-2225
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Fax | 781-398-2221
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Provider Business Mailing Address
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Address Line | 5 FEDERAL ST UNIT 1881
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City | NANTUCKET
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State | MA
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Zip | 02554-1703
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Country | US
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Telephone | 781-398-2225
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Fax | 781-398-2221
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Authorized Official
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Title or Position | DIRECTOR
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Name | ABRAR A QURESHI
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Credential | MD, MPH
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Telephone | 781-398-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | 205049
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 205049
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License Number State | MA
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