Organization
DERMATOLOGY ASSOCIATES OF THE NORTHEAST, PC
Active
Organization
DERMATOLOGY ASSOCIATES OF THE NORTHEAST, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JORGE LUIS CRESPO MD (PRESIDENT)
(800) 303-8984
Entity
Organization
Contact information
Practice address
745A ROUTE 63, CHESTERFIELD, NH 03443-3604
(800) 303-8984
(603) 363-4450
Mailing address
PO BOX 910, GREENFIELD, MA 01302-0910
(413) 772-8500
(413) 772-8900
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0104793Y0VT01
BC/BS
NH
05
—
30003577
—
NH
05
—
30212525
—
NH
01
—
8233
BC/BS
VT
05
—
OVN2029
—
VT
Enumeration date
05/18/2006
Last updated
11/01/2007
Update your record
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