NPIMap

Organization Active NPI

Northeast Dermatology Associates, PC

  • Dermatology Physician
  • Beverly, MA
National Provider Identifier
1407258494
Registry record updated Sep 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
NORTHEAST DERMATOLOGY ASSOCIATES, PC
Practice address
138 Conant St
Beverly, MA 01915-1665
Phone
(978) 927-5254
NPI assigned
Sep 22, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2014

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

Authorized official

Name
Leila Bell
Title
Ceo
Phone
(978) 691-5699

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X MA Primary
MOHS-Micrographic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ND0101X MA
Dermatopathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ND0900X MA

Addresses

Primary practice location

138 Conant St
Beverly, MA 01915-1665

Mailing address

401 Andover St
Suite 101
North Andover, MA 01845-5076
Phone (978) 691-5690

Other names 1

  • NEDA Other name

National Provider Directory

National Provider Directory
Tax ID family
Northeast Dermatology Associates PC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

401 Andover St
Ste 101
North Andover, MA 01845
Phone (978) 746-5295

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1411344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411344000000",
    "number": "1407258494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 ANDOVER ST",
            "address_2": "SUITE 101",
            "city": "NORTH ANDOVER",
            "state": "MA",
            "postal_code": "018455076",
            "telephone_number": "978-691-5690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 CONANT ST",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019151665",
            "telephone_number": "978-927-5254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST DERMATOLOGY ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-22",
        "last_updated": "2014-09-22",
        "status": "A",
        "authorized_official_last_name": "BELL",
        "authorized_official_first_name": "LEILA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "978-691-5699"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "MA",
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "MA",
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": "MA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NEDA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Beverly, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.