Organization
CRANBERRY SQUARE DERMATOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMY BETH KOFF M.D. (OWNER)
(508) 394-5556
Entity
Organization
Contact information
Practice address
434 ROUTE 134, SUITE 1A, SOUTH DENNIS, MA 02660-3433
(508) 394-5556
(508) 394-2735
Mailing address
434 ROUTE 134, SUITE 1A, SOUTH DENNIS, MA 02660-3433
(508) 394-5556
(508) 394-2735
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
80792
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000M16787
BLUE CROSS BLUE SHIELD
MA
Enumeration date
04/17/2007
Last updated
08/28/2014
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