MEDICARE: DERMATOLOGY ASSOCIATES OF THE SOUTH SHORE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ND0900X	Dermatopathology Physician	48199	MA
2	207NS0135X	Procedural Dermatology Physician	48199	MA
3	207N00000X	Dermatology Physician	48199	MA

General Provider Information

NPI Number	:	1568552594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMATOLOGY ASSOCIATES OF THE SOUTH SHORE PC

Provider Business Mailing Address
First Line	:	8 MARKET CROSSING
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-7736
Country	:	US
Telephone Number	:	508-224-3800
Fax Number	:	508-224-3830

Provider Business Practice Location Address
First Line	:	8 MARKET CROSSING
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-7736
Country	:	US
Telephone Number	:	508-224-3800
Fax Number	:	508-224-3830

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARCOS SASTRE
Credential	:	MD
Telephone Number	:	508-224-3800

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	09/11/2025

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