Provider Demographics
NPI:1427676394
Name:WELLESLEY DERMATOLOGY CARE LLC
Entity type:Organization
Organization Name:WELLESLEY DERMATOLOGY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RASHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-227-7977
Mailing Address - Street 1:130 HARTMAN RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2854
Mailing Address - Country:US
Mailing Address - Phone:617-584-0229
Mailing Address - Fax:
Practice Address - Street 1:65 WALNUT ST STE 440
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2196
Practice Address - Country:US
Practice Address - Phone:781-227-7997
Practice Address - Fax:713-903-7905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty