Organization
COASTAL APDERM MASS, LLC
Active
Parent organization
COASTAL DERMATOLOGY INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
COASTAL DERMATOLOGY INC
Authorized official
SAMUEL GOOS (OWNER)
(978) 371-7010
Entity
Organization
Contact information
Practice address
829 AMERICAN LEGION HWY, WESTPORT, MA 02790-4128
(978) 371-7010
Mailing address
526 MAIN ST STE 302, ACTON, MA 01720-3301
(978) 371-7010
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
04/20/2022
Last updated
04/20/2022
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