Provider Demographics
NPI:1104217686
Name:DERMATOLOGY SERVICES ND
Entity type:Organization
Organization Name:DERMATOLOGY SERVICES ND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUMENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-993-7601
Mailing Address - Street 1:145 FAUNCE CORNER MALL RD
Mailing Address - Street 2:
Mailing Address - City:N DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-6216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:232 ROCK ODUNDEE RD
Practice Address - Street 2:
Practice Address - City:S DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02748-1428
Practice Address - Country:US
Practice Address - Phone:508-990-8199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty