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
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