Provider Demographics
NPI:1104921162
Name:NORTHEAST DERMATOLOGY ASSOCIATES, PC
Entity type:Organization
Organization Name:NORTHEAST DERMATOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:P
Authorized Official - Last Name:FINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-691-5690
Mailing Address - Street 1:280 MERRIMACK STREET
Mailing Address - Street 2:SUITE 311
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1779
Mailing Address - Country:US
Mailing Address - Phone:978-691-5690
Mailing Address - Fax:978-691-5693
Practice Address - Street 1:538 TURNPIKE ST
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845
Practice Address - Country:US
Practice Address - Phone:978-683-9201
Practice Address - Fax:978-686-2770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAG92172Medicare UPIN
MEMM6161Medicare PIN
MAB58000Medicare UPIN
MAB73677Medicare UPIN
MEH28566Medicare UPIN
MAB73682Medicare UPIN
NHA58205Medicare UPIN
MAB38255Medicare UPIN
NHF25527Medicare UPIN
NHH09161Medicare UPIN
MAM15432Medicare PIN
MAG03932Medicare UPIN