Provider Demographics
NPI:1811965296
Name:ATTLEBORO DERMATOLOGY, P.C.
Entity type:Organization
Organization Name:ATTLEBORO DERMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SAMEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-226-0400
Mailing Address - Street 1:152 EMORY ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2434
Mailing Address - Country:US
Mailing Address - Phone:508-226-0400
Mailing Address - Fax:508-226-3301
Practice Address - Street 1:152 EMORY ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2434
Practice Address - Country:US
Practice Address - Phone:508-226-0400
Practice Address - Fax:508-226-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76041207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0005389OtherBLUE CHIP
MACK7613OtherRAILROAD MEDICARE
RI227085OtherRHODE ISLAND B/SHIELD
MA695110OtherTUFTS
MA9722301Medicaid
MA401164OtherHARVARD PILGRIM
MAM18034OtherBLUE SHIELD
MACK7613OtherRAILROAD MEDICARE