Organization
DERMASAP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACI GOODWIN (OM)
(617) 472-6764
Entity
Organization
Contact information
Practice address
500 CONGRESS ST, B1, QUINCY, MA 02169-0908
(617) 472-6764
Mailing address
500 CONGRESS ST, B1, QUINCY, MA 02169-0908
(617) 472-6764
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
49076
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
043214763
—
MA
Enumeration date
07/20/2015
Last updated
12/27/2016
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