Provider Demographics
NPI:1861023590
Name:ESSENTIAL DERMATOLOGY, PLLC
Entity Type:Organization
Organization Name:ESSENTIAL DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:KRATHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-827-2615
Mailing Address - Street 1:220 N MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-1100
Mailing Address - Country:US
Mailing Address - Phone:508-827-2615
Mailing Address - Fax:508-827-2616
Practice Address - Street 1:220 N MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1100
Practice Address - Country:US
Practice Address - Phone:508-827-2615
Practice Address - Fax:508-827-2616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-31
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty