Provider Demographics
NPI:1144575473
Name:KMN DERMATOLOGY & AESTHETICS PC
Entity Type:Organization
Organization Name:KMN DERMATOLOGY & AESTHETICS PC
Other - Org Name:D/B/A - SKIN & WITHIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:AHERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-346-3579
Mailing Address - Street 1:146 MAIN ST,
Mailing Address - Street 2:STE 2B
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056-1322
Mailing Address - Country:US
Mailing Address - Phone:508-346-3579
Mailing Address - Fax:508-346-3967
Practice Address - Street 1:146 MAIN ST,
Practice Address - Street 2:STE 2B
Practice Address - City:NORFOLK
Practice Address - State:MA
Practice Address - Zip Code:02056-1322
Practice Address - Country:US
Practice Address - Phone:508-346-3579
Practice Address - Fax:508-346-3967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty