Basic Information
| Provider Information | |||||||||
| NPI: | 1558477869 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEWTON WATERTOWN DERMATOLOGY ASSOC. PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 280 WASHINGTON ST | ||||||||
| Address2: | #212 | ||||||||
| City: | BRIGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021353511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177837100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 280 WASHINGTON ST | ||||||||
| Address2: | #212 | ||||||||
| City: | BRIGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021353511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177837100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | AMSTER | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | STEWART | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO-PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6177837100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 70448 | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.