Organization
DERMWELLESLEY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMILY WISE MD (OWNER)
(857) 317-2057
Entity
Organization
Contact information
Practice address
20 WILLIAM ST, WELLESLEY, MA 02481-4103
(781) 591-4234
(781) 369-9737
Mailing address
20 WILLIAM ST, WELLESLEY, MA 02481-4103
(781) 591-4234
(857) 317-2811
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
254256
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1487882270
INDIVIDUAL NPI
—
Enumeration date
08/24/2018
Last updated
01/03/2019
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