Provider Demographics
NPI:1003005331
Name:DERMATOLOGY & SKIN CARE ASSOC PC
Entity Type:Organization
Organization Name:DERMATOLOGY & SKIN CARE ASSOC PC
Other - Org Name:DERMATOLOGY ASSOCIATES OF GREATER BOSTON PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:K
Authorized Official - Last Name:WEINFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-235-8155
Mailing Address - Street 1:10 LAUREL AVE SUITE 300
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481
Mailing Address - Country:US
Mailing Address - Phone:781-235-8155
Mailing Address - Fax:781-235-2855
Practice Address - Street 1:10 LAUREL AVE SUITE 300
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481
Practice Address - Country:US
Practice Address - Phone:781-235-8155
Practice Address - Fax:781-235-2855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216859207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM19446OtherBCBS
H90994Medicare UPIN