Organization
VIBRANT DERMATOLOGY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOYCE IMAHIYEROBO MD (OWNER/PROVIDER)
(617) 840-9034
Entity
Organization
Contact information
Practice address
588 PROVIDENCE HWY, DEDHAM, MA 02026-6804
(781) 708-9299
(855) 699-6813
Mailing address
226 DEDHAM ST, CANTON, MA 02021-1566
(617) 840-9034
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
254815
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110098002A
—
MA
Enumeration date
04/12/2018
Last updated
02/29/2020
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