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General NPI Number Information
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NPI Number | 1750201299
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Entity Type | Organization
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Legal Business Name | OPTIMA DERMATOLOGY MA1 PLLC
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Dates
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Enumeration Date | 07/16/2026
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Last Update Date | 07/16/2026
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Provider Practice Location Address
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Address Line | 3 CHERRY ST STE 100
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City | NEWBURYPORT
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State | MA
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Zip | 01950-3973
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Country | US
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Telephone | 855-277-9689
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Fax |
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Provider Business Mailing Address
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Address Line | 111 NEW HAMPSHIRE AVE STE 2
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City | PORTSMOUTH
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State | NH
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Zip | 03801-2864
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | JOHN BERNAT
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Credential | MD
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Telephone | 330-965-8760
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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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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number |
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License Number State |
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