Organization
CAPE COD DERMATOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM WYMAN FISKE M.D. (OWNER/PHYSICIAN)
(508) 771-9779
Entity
Organization
Contact information
Practice address
134 ANSEL HALLET RD, W YARMOUTH, MA 02673-2582
(508) 771-9779
(508) 771-4355
Mailing address
134 ANSEL HALLET RD, W YARMOUTH, MA 02673-2582
(508) 771-9779
(508) 771-4355
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
74240
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11095135A
—
MA
01
—
J11263
BCBS
MA
01
—
P00429633
RAILROAD MEDICARE
LA
Enumeration date
05/22/2013
Last updated
05/22/2013
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