Provider Demographics
NPI:1609813237
Name:SKOLNIK, IRA L (MD)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:L
Last Name:SKOLNIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 MAIN STREET
Mailing Address - Street 2:SUITE 212
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-3330
Mailing Address - Country:US
Mailing Address - Phone:978-369-7701
Mailing Address - Fax:978-369-7702
Practice Address - Street 1:747 MAIN ST
Practice Address - Street 2:SUITE 212
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3302
Practice Address - Country:US
Practice Address - Phone:978-369-7701
Practice Address - Fax:978-369-7702
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209782207N00000X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAG93077Medicare UPIN