Provider Demographics
NPI:1558477869
Name:NEWTON WATERTOWN DERMATOLOGY ASSOC. PC
Entity Type:Organization
Organization Name:NEWTON WATERTOWN DERMATOLOGY ASSOC. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:AMSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-783-7100
Mailing Address - Street 1:280 WASHINGTON ST
Mailing Address - Street 2:#212
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3511
Mailing Address - Country:US
Mailing Address - Phone:617-783-7100
Mailing Address - Fax:
Practice Address - Street 1:280 WASHINGTON ST
Practice Address - Street 2:#212
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3511
Practice Address - Country:US
Practice Address - Phone:617-783-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA70448207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM20359Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER