Provider Demographics
NPI:1326166596
Name:NEWTON WELLESLEY DERMATOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:NEWTON WELLESLEY DERMATOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:AGHASSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-237-3500
Mailing Address - Street 1:65 WALNUT ST
Mailing Address - Street 2:SUITE 520
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2118
Mailing Address - Country:US
Mailing Address - Phone:781-237-3500
Mailing Address - Fax:781-237-7867
Practice Address - Street 1:65 WALNUT ST
Practice Address - Street 2:SUITE 520
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2118
Practice Address - Country:US
Practice Address - Phone:781-237-3500
Practice Address - Fax:781-237-7867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157066207N00000X
MA75461207N00000X
MA58820207N00000X
MA238807207N00000X
MA2027363A00000X
MAPA1800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM15645Medicare ID - Type Unspecified