Provider Demographics
NPI:1699180620
Name:NORTHEAST DERMATOLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:NORTHEAST DERMATOLOGY ASSOCIATES, PC
Other - Org Name:NEDA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:P
Authorized Official - Last Name:FINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-691-5690
Mailing Address - Street 1:401 ANDOVER STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5076
Mailing Address - Country:US
Mailing Address - Phone:978-691-5690
Mailing Address - Fax:978-691-5693
Practice Address - Street 1:138 CONANT ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1665
Practice Address - Country:US
Practice Address - Phone:978-691-5690
Practice Address - Fax:978-691-5693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-28
Last Update Date:2014-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB58000Medicare UPIN
MAG92172Medicare UPIN
NHF25527Medicare UPIN
MAM15432Medicare PIN
NHA58205Medicare UPIN
MAG03932Medicare UPIN
MAB38255Medicare UPIN
MAB73677Medicare UPIN
MAB73682Medicare UPIN
MEMM6161Medicare UPIN
NHH09161Medicare UPIN
MEH28566Medicare UPIN