Provider Demographics
NPI:1003161381
Name:WESTFORD DERMATOLOGY AND COSMETIC CENTER LLC
Entity Type:Organization
Organization Name:WESTFORD DERMATOLOGY AND COSMETIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEALTHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLIVIERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-244-3322
Mailing Address - Street 1:506 GROTON RD
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-6326
Mailing Address - Country:US
Mailing Address - Phone:978-399-0061
Mailing Address - Fax:978-399-0069
Practice Address - Street 1:506 GROTON RD
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-6326
Practice Address - Country:US
Practice Address - Phone:978-399-0061
Practice Address - Fax:978-399-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207N00000X
MA1671363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty