Provider Demographics
NPI:1699036830
Name:DERRY DERMATOLOGY, PLLC
Entity Type:Organization
Organization Name:DERRY DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ZABAWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:603-818-8374
Mailing Address - Street 1:1C COMMONS DR UNIT 16
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3441
Mailing Address - Country:US
Mailing Address - Phone:603-818-8374
Mailing Address - Fax:
Practice Address - Street 1:1C COMMONS DR UNIT 16
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3441
Practice Address - Country:US
Practice Address - Phone:603-818-8374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14825207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty