Canton Dermatology Clinic, Inc

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

Legal business name

CANTON DERMATOLOGY CLINIC, INC

Practice address

95 Washington St
Canton, MA 02021-4006

Phone

(781) 821-2888

Fax

(781) 821-8684

NPI assigned

Oct 25, 2006

Organization subpart

No

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

Authorized official

Name

Jafar Koupaie, MDNPI 1508940644

Title

President

Phone

(781) 821-2888

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Practitioners 1

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

• Jafar Koupaie, MD

  • Procedural Dermatology Physician
  • Riverside, CA
  • NPI 1508940644

  MA

  Medicare reassignment Authorized official

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407715200000",
    "number": "1295819290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 WASHINGTON ST",
            "city": "CANTON",
            "state": "MA",
            "postal_code": "020214006",
            "telephone_number": "781-821-2888",
            "fax_number": "781-821-8684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 WASHINGTON ST",
            "city": "CANTON",
            "state": "MA",
            "postal_code": "020214006",
            "telephone_number": "781-821-2888",
            "fax_number": "781-821-8684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANTON DERMATOLOGY CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2014-08-11",
        "status": "A",
        "authorized_official_last_name": "KOUPAIE",
        "authorized_official_first_name": "JAFAR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-821-2888",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Camerota, R.D.
• Christina Cange
• Canton Adh LLC
• Canton Dale Chiropractic, Inc.
• Canton Dental Group
• Canton Family Dental PLLC
• Canton Modern Dentistry, PC
• Canton Nursing LLC
• Canton Podaitry Associates
• Cape Medical Supply, Inc.

• All providers in Canton, MA
• Procedural Dermatology Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.