Organization
WORCESTER DERMATOLOGY ASSOCIATES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS LORI KIXMILLER (OFFICE MANAGER)
(508) 754-3823
Entity
Organization
Contact information
Practice address
100 CENTRAL ST, WORCESTER, MA 01608-1209
(508) 754-3823
(508) 753-0151
Mailing address
100 MARTIN LUTHER KING JR BLVD, WORCESTER, MA 01608-1209
(508) 754-3823
(508) 753-0151
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
75849
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9700340
—
MA
01
—
M17485
BLUE SHIELD GROUP NUMBER
MA
Enumeration date
11/03/2005
Last updated
02/13/2021
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