Provider Demographics
NPI:1669463493
Name:CHELMSFORD DERMATOLOGY, P.C.
Entity Type:Organization
Organization Name:CHELMSFORD DERMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SIMKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-256-4151
Mailing Address - Street 1:3 VILLAGE SQ
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2712
Mailing Address - Country:US
Mailing Address - Phone:978-256-4151
Mailing Address - Fax:978-256-3987
Practice Address - Street 1:3 VILLAGE SQ
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2712
Practice Address - Country:US
Practice Address - Phone:978-256-4151
Practice Address - Fax:978-256-3987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9771719Medicaid
MA9771719Medicaid