Provider Demographics
NPI:1750691010
Name:BOUGHTON DERMATOLOGY
Entity type:Organization
Organization Name:BOUGHTON DERMATOLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTOANELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALAME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-353-5159
Mailing Address - Street 1:7300 GIRARD AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5138
Mailing Address - Country:US
Mailing Address - Phone:858-454-7123
Mailing Address - Fax:858-454-5724
Practice Address - Street 1:7300 GIRARD AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-5138
Practice Address - Country:US
Practice Address - Phone:858-454-7123
Practice Address - Fax:858-454-5724
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPASS DERMATOPATHOLOGY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty