Provider Demographics
NPI:1568552594
Name:DERMATOLOGY ASSOCIATES OF THE SOUTH SHORE PC
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF THE SOUTH SHORE PC
Other - Org Name:MARCOS SASTRE MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:
Authorized Official - Last Name:SASTRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-224-3800
Mailing Address - Street 1:8 MARKET CROSSING
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-7736
Mailing Address - Country:US
Mailing Address - Phone:508-224-3800
Mailing Address - Fax:508-224-3830
Practice Address - Street 1:8 MARKET CROSSING
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7736
Practice Address - Country:US
Practice Address - Phone:508-224-3800
Practice Address - Fax:508-224-3830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA48199207N00000X, 207ND0900X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Not Answered207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
Not Answered207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A66376Medicare UPIN
M13960Medicare ID - Type Unspecified