Provider Demographics
NPI:1689944811
Name:NANTUCKET DERMATOLOGY, LLC
Entity Type:Organization
Organization Name:NANTUCKET DERMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ABRAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:QURESHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:781-398-2225
Mailing Address - Street 1:5 FEDERAL ST UNIT 1881
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-1703
Mailing Address - Country:US
Mailing Address - Phone:781-398-2225
Mailing Address - Fax:781-398-2221
Practice Address - Street 1:4.5 BARTLETT RD
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554
Practice Address - Country:US
Practice Address - Phone:781-398-2225
Practice Address - Fax:781-398-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205049207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty