NPIMap

Organization Active NPI

Watertown Dermatology Associates, LLC

  • Dermatology Physician
  • Watertown, MA
National Provider Identifier
1609397371
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
53035 Issued in MA
Legal business name
WATERTOWN DERMATOLOGY ASSOCIATES, LLC
Practice address
40 Spring St
Watertown, MA 02472-3474
Phone
(617) 923-8433
Fax
(617) 923-8466
NPI assigned
Jul 3, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Kerri Larosa
Title
Office Manager
Phone
(617) 923-8433

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 71817 MA
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 53035 MA Primary

Addresses

Primary practice location

40 Spring St
Watertown, MA 02472-3474

Mailing address

40 Spring St
Watertown, MA 02472-3474
Phone (617) 923-8433

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1499040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1609397371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 SPRING ST",
            "city": "WATERTOWN",
            "state": "MA",
            "postal_code": "024723474",
            "telephone_number": "617-923-8433",
            "fax_number": "617-923-8466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 SPRING ST",
            "city": "WATERTOWN",
            "state": "MA",
            "postal_code": "024723474",
            "telephone_number": "617-923-8433",
            "fax_number": "617-923-8466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERTOWN DERMATOLOGY ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-03",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "LAROSA",
        "authorized_official_first_name": "KERRI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "617-923-8433"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "MA",
            "license": "71817",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "MA",
            "license": "53035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, MA

Sources for this page

  • 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.