Provider Demographics
NPI:1184637464
Name:NORTH ANDOVER DERMATOLOGY INC
Entity Type:Organization
Organization Name:NORTH ANDOVER DERMATOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCTS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JO
Authorized Official - Middle Name:P
Authorized Official - Last Name:MARCHISIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-687-3335
Mailing Address - Street 1:198 MASSACHUSETTS AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-4143
Mailing Address - Country:US
Mailing Address - Phone:978-687-3335
Mailing Address - Fax:978-689-9041
Practice Address - Street 1:198 MASSACHUSETTS AVE
Practice Address - Street 2:STE 105
Practice Address - City:N ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-4143
Practice Address - Country:US
Practice Address - Phone:978-687-3335
Practice Address - Fax:978-689-9041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150484207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1184637464OtherNPI
MA9775927Medicaid
MAA16757Medicare PIN