Individual
DR. JACK KRUSHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
40 HOLLAND ST, DERMATOLOGY DEPT., SOMERVILLE, MA 02144-2705
(617) 629-6250
(617) 629-6108
Mailing address
40 HOLLAND ST, DERMATOLOGY DEPT., SOMERVILLE, MA 02144-2705
(617) 629-6250
(617) 629-6108
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
74445
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3204545
—
MA
Enumeration date
05/01/2006
Last updated
01/25/2021
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