Provider Demographics
NPI:1265098032
Name:MARK AMSTER DERM
Entity type:Organization
Organization Name:MARK AMSTER DERM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED GROUP OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:AMSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-783-7100
Mailing Address - Street 1:800 FALMOUTH RD STE 101B
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-3352
Mailing Address - Country:US
Mailing Address - Phone:617-783-7100
Mailing Address - Fax:
Practice Address - Street 1:800 FALMOUTH RD STE 101B
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3352
Practice Address - Country:US
Practice Address - Phone:617-783-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty