Organization
SOUTH SHORE SKIN CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD F EISEN M.D. (MANAGER)
(508) 747-0711
Entity
Organization
Contact information
Practice address
1 SCOBEE CIR, UNIT 3, PLYMOUTH, MA 02360-4887
(508) 747-0711
(508) 746-9265
Mailing address
1 SCOBEE CIR, UNIT 3, PLYMOUTH, MA 02360-4887
(508) 747-0711
(508) 746-9265
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
685603
TUFTS HEALTH PLAN
MA
01
—
M17452
BLUE CROSS AND BLUE SHIEL
MA
Enumeration date
01/05/2006
Last updated
06/29/2015
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