Provider Demographics
NPI:1508964230
Name:DERMATOLOGY ASSOCIATES OF CONCORD INC
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF CONCORD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:P
Authorized Official - Last Name:HADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-369-9023
Mailing Address - Street 1:290 BAKER AVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2189
Mailing Address - Country:US
Mailing Address - Phone:978-369-9023
Mailing Address - Fax:978-371-9675
Practice Address - Street 1:290 BAKER AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2189
Practice Address - Country:US
Practice Address - Phone:978-369-9023
Practice Address - Fax:978-371-9675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM11607OtherBLUE S HIELD
MA9703713Medicaid
MA9703713Medicaid