Provider Demographics
NPI:1497120802
Name:DERMATOLOGY AND SKIN SURGERY CENTER OF CAPE COD P.C.
Entity Type:Organization
Organization Name:DERMATOLOGY AND SKIN SURGERY CENTER OF CAPE COD P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:P
Authorized Official - Last Name:TIERNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-957-1650
Mailing Address - Street 1:120 YARMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3040
Mailing Address - Country:US
Mailing Address - Phone:508-957-1650
Mailing Address - Fax:508-957-1655
Practice Address - Street 1:120 YARMOUTH RD
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3040
Practice Address - Country:US
Practice Address - Phone:508-957-1650
Practice Address - Fax:508-957-1655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110108806AMedicaid
MAS100278599Medicare PIN