Provider Demographics
NPI:1033625868
Name:SKIN DERMATOLOGY COMPANY
Entity Type:Organization
Organization Name:SKIN DERMATOLOGY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISSA
Authorized Official - Middle Name:T
Authorized Official - Last Name:LAMOUREUX
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:508-644-0505
Mailing Address - Street 1:555 MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-2932
Mailing Address - Country:US
Mailing Address - Phone:508-644-0505
Mailing Address - Fax:508-644-0506
Practice Address - Street 1:555 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545
Practice Address - Country:US
Practice Address - Phone:508-644-0505
Practice Address - Fax:508-644-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-15
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty