Provider Demographics
NPI:1205405834
Name:COMMONWEALTH DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:COMMONWEALTH DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SADAF
Authorized Official - Middle Name:
Authorized Official - Last Name:WAQAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-654-1789
Mailing Address - Street 1:100 MLK JR BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1209
Mailing Address - Country:US
Mailing Address - Phone:774-389-0887
Mailing Address - Fax:
Practice Address - Street 1:100 MLK JR BLVD STE 200
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1209
Practice Address - Country:US
Practice Address - Phone:774-389-0887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty