Provider Demographics
NPI:1962524629
Name:KRAUSS DERMATOLOGY PC
Entity type:Organization
Organization Name:KRAUSS DERMATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCALLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-416-3500
Mailing Address - Street 1:1 WASHINGTON ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-1711
Mailing Address - Country:US
Mailing Address - Phone:781-416-3500
Mailing Address - Fax:781-416-3505
Practice Address - Street 1:1 WASHINGTON ST
Practice Address - Street 2:SUITE 401
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-1711
Practice Address - Country:US
Practice Address - Phone:781-416-3500
Practice Address - Fax:781-416-3505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM19075OtherBCBS GROUP #
MAM19075OtherBCBS GROUP #