Individual
MIA ALYSE MOLOGOUSIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
800 WASHINGTON ST, BOSTON, MA 02111-1552
(617) 636-5000
Mailing address
8027 SAVOY CLUB CT, BURR RIDGE, IL 60527
(630) 991-7500
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
3017989
MA
Other
Enumeration date
03/27/2023
Last updated
05/21/2025
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