Provider Demographics
NPI:1639499676
Name:SKINCARE PHYSICIANS ST ELIZABETHS INC
Entity type:Organization
Organization Name:SKINCARE PHYSICIANS ST ELIZABETHS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:KILAWEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-848-1611
Mailing Address - Street 1:1244 BOYLSTON ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2116
Mailing Address - Country:US
Mailing Address - Phone:617-731-1600
Mailing Address - Fax:617-731-1601
Practice Address - Street 1:1244 BOYLSTON ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2116
Practice Address - Country:US
Practice Address - Phone:617-731-1600
Practice Address - Fax:617-731-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM21034Medicare PIN