Provider Demographics
NPI:1962278523
Name:IDG OF CAPE COD
Entity type:Organization
Organization Name:IDG OF CAPE COD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:AMSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-721-6552
Mailing Address - Street 1:PO BOX 590129
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02459-0002
Mailing Address - Country:US
Mailing Address - Phone:617-721-6552
Mailing Address - Fax:617-783-7104
Practice Address - Street 1:800 FALMOUTH RD STE 101B
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3303
Practice Address - Country:US
Practice Address - Phone:617-783-7100
Practice Address - Fax:617-783-7104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty