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General NPI Number Information
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NPI Number | 1710387386
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Entity Type | Organization
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Legal Business Name | ASSOCIATES OF SOUTH SHORE DERMATOLOGY LLC
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Dates
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Enumeration Date | 09/02/2014
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Last Update Date | 09/17/2014
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Provider Practice Location Address
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Address Line | 300 CONGRESS ST STE 408
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City | QUINCY
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State | MA
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Zip | 02169-0907
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Country | US
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Telephone | 617-773-7431
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Fax | 617-773-9592
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Provider Business Mailing Address
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Address Line | 300 CONGRESS ST STE 408
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City | QUINCY
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State | MA
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Zip | 02169
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Country | US
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Telephone | 617-773-7431
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Fax | 617-773-9592
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN G WERTH
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Credential | MD
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Telephone | 617-773-7431
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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 | 73556
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License Number State | MA
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