Provider Demographics
NPI:1558607887
Name:APDERM NORTH, PC
Entity Type:Organization
Organization Name:APDERM NORTH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:978-849-7501
Mailing Address - Street 1:526 MAIN ST STE 302
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3301
Mailing Address - Country:US
Mailing Address - Phone:978-371-7010
Mailing Address - Fax:978-371-0522
Practice Address - Street 1:526 MAIN ST STE 302
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3301
Practice Address - Country:US
Practice Address - Phone:978-371-7010
Practice Address - Fax:978-371-0522
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADULT & PEDIATRIC DERMATOLOGY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty