Provider Demographics
NPI:1780635342
Name:DERMATOLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES, LLC
Other - Org Name:DERMATOLOGY ASSOCIATES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:GORMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-775-3526
Mailing Address - Street 1:50 SEWALL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2624
Mailing Address - Country:US
Mailing Address - Phone:207-775-3526
Mailing Address - Fax:207-775-5658
Practice Address - Street 1:50 SEWALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2624
Practice Address - Country:US
Practice Address - Phone:207-775-3526
Practice Address - Fax:207-775-5658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME131510100Medicaid
MEMM7242Medicare ID - Type Unspecified