Organization
MYSTIC VALLEY MASS, PC
Active
Parent organization
MYSTIC VALLEY DERMATOLOGY ASSOCIATES, P.C.
Organization subpart
Yes
Provider details
NPI number
Legal business name
MYSTIC VALLEY DERMATOLOGY ASSOCIATES, P.C.
Authorized official
SAMUEL GOOS (OWNER)
(783) 717-0109
Entity
Organization
Contact information
Practice address
92 MONTVALE AVE STE 3000, STONEHAM, MA 02180-3658
(781) 438-6350
Mailing address
526 MAIN ST STE 302, ACTON, MA 01720-3301
(978) 371-7010
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
01/28/2022
Last updated
01/28/2022
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