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General NPI Number Information
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NPI Number | 1841360716
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Entity Type | Organization
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Legal Business Name | CENTER FOR BLISTERING DISEASES, INC
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 11/10/2016
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Provider Practice Location Address
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Address Line | 697 CAMBRIDGE ST SUITE 302
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City | BOSTON
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State | MA
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Zip | 02135-2897
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Country | US
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Telephone | 617-562-1040
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Fax | 617-562-1047
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Provider Business Mailing Address
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Address Line | 697 CAMBRIDGE ST SUITE 302
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City | BOSTON
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State | MA
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Zip | 02135-2897
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Country | US
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Telephone | 617-562-1040
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Fax | 617-562-1047
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Authorized Official
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Title or Position | PRESIDENT
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Name | ABDUL RAZZAQUE AHMED
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Credential | MD
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Telephone | 617-562-1040
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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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