Integrated Dermatology of Chesterfield LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

INTEGRATED DERMATOLOGY OF CHESTERFIELD LLC

Practice address

745A Route 63
Chesterfield, NH 03443-3604

Phone

(603) 363-4469

Fax

(603) 363-4450

NPI assigned

Jan 23, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jeffrey Queen

Title

Owner

Phone

(561) 314-2000

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NH

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jorge Luis Crespo, MD

  • Dermatology Physician
  • Chesterfield, NH
  • NPI 1881633568
  Medicare reassignment Care Compare group NPD
• Lisa Davey Ahava, PA

  • Physician Assistant
  • Chesterfield, NH
  • NPI 1487693453
  Medicare reassignment Care Compare group
• Rebecca M Jones, MD

  • Dermatology Physician
  • Brattleboro, VT
  • NPI 1861432841
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1327276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1265703235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 EXCHANGE CT STE 110",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334314450",
            "telephone_number": "561-314-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745A ROUTE 63",
            "city": "CHESTERFIELD",
            "state": "NH",
            "postal_code": "034433604",
            "telephone_number": "603-363-4469",
            "fax_number": "603-363-4450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED DERMATOLOGY OF CHESTERFIELD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-23",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "QUEEN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "561-314-2000"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "NH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Davey Ahava, PA
• Jorge Luis Crespo, MD
• Dermatology Associates of the Northeast, PC

• Dermatology Physician in Chesterfield, NH
• Providers in Chesterfield, NH by specialty
• Dermatology Physician in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.