MEDICARE: ADVANCED DERMATOLOGY AND AESTHETIC CENTER LLC

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	207N00000X	Dermatology Physician	156364	MA

General Provider Information

NPI Number	:	1568907533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED DERMATOLOGY AND AESTHETIC CENTER LLC

Provider Business Mailing Address
First Line	:	526 MAIN ST STE 302
Second Line	:
City	:	ACTON
State	:	MA
Zip	:	01720-3301
Country	:	US
Telephone Number	:	978-849-7537
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 CITY HALL PLZ
Second Line	:
City	:	MELROSE
State	:	MA
Zip	:	02176-3149
Country	:	US
Telephone Number	:	781-662-8881
Fax Number	:	781-662-8886

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	DR. SAMUEL GOOS
Credential	:	M.D.
Telephone Number	:	978-371-7010

Provider Enumeration Date	:	12/30/2016
Last Update Date	:	01/24/2024

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