Provider Demographics
NPI:1558834523
Name:DERMPHYSICIANS OF NEW ENGLAND LLC
Entity Type:Organization
Organization Name:DERMPHYSICIANS OF NEW ENGLAND LLC
Other - Org Name:DERMPHYSICIANS OF NEW ENGLAND I LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTERPOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-272-7022
Mailing Address - Street 1:83 CAMBRIDGE ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4181
Mailing Address - Country:US
Mailing Address - Phone:781-272-7022
Mailing Address - Fax:781-272-8786
Practice Address - Street 1:83 CAMBRIDGE ST STE 1A
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4181
Practice Address - Country:US
Practice Address - Phone:781-272-7022
Practice Address - Fax:781-272-8786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-02
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty