Provider Demographics
NPI:1710342878
Name:LEOMINSTER DERMATOLOGY LLP
Entity Type:Organization
Organization Name:LEOMINSTER DERMATOLOGY LLP
Other - Org Name:DERMATOLOGY ASSOCIATES OF WORCESTER COUNTY PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SUPERVISING MD
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-534-0582
Mailing Address - Street 1:100 HOSPITAL RD STE 2D
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-2253
Mailing Address - Country:US
Mailing Address - Phone:978-534-0582
Mailing Address - Fax:978-534-6519
Practice Address - Street 1:100 HOSPITAL RD STE 2D
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-2253
Practice Address - Country:US
Practice Address - Phone:978-534-0582
Practice Address - Fax:978-534-6519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-16
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55708207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0173754Medicaid
MAA38366Medicare UPIN