Provider Type Icon

MYSTIC VALLEY DERMATOLOGY ASSOCIATES P.C. NPI 1548213606


NPI Information

NPI: 1548213606
Provider Name: MYSTIC VALLEY DERMATOLOGY ASSOCIATES, P.C.
Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 30D2044558

Address:
92 MONTVALE AVE STE 3000
STONEHAM, MA
ZIP 02180
Phone: (781) 438-6350
Get Directions

MYSTIC VALLEY DERMATOLOGY ASSOCIATES, P.C. is a specialist in Stoneham, MA. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. MYSTIC VALLEY DERMATOLOGY ASSOCIATES, P.C. NPI is 1548213606. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

92 MONTVALE AVE STE 3000
STONEHAM, MA
ZIP 02180-658
Phone: (781) 438-6350
Fax: (781) 279-0430

The provider's authorized official is Samuel D Goos .
The authorized official title is Managing Partner and has the following contact phone number (978) 371-7010.

The CLIA number assigned to this NPI record is 30D2044558 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 5/18/2006 and was last updated on 9/11/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1174400000XSpecialistMASSACHUSETTSYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.