Provider Demographics
NPI:1508396623
Name:FAMILY DERMATOLOGY, P.C.
Entity Type:Organization
Organization Name:FAMILY DERMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SKOLNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-369-7701
Mailing Address - Street 1:747 MAIN STREET, SUITE #212
Mailing Address - Street 2:FAMILY DERMATOLOGY, P.C.
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742
Mailing Address - Country:US
Mailing Address - Phone:978-369-7701
Mailing Address - Fax:
Practice Address - Street 1:747 MAIN ST STE 212
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3330
Practice Address - Country:US
Practice Address - Phone:978-369-7701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209782207N00000X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Single Specialty