Premier Dermatology, PLLC
Organization Active NPI Dermatology Physician · Wellesley, MA
NPI 1669028353 · NPPES record last updated Aug 18, 2019
Key facts
- NPI
- 1669028353
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- Legal business name
- PREMIER DERMATOLOGY, PLLC
- Practice address
- 372 Washington St
2ND Floor
Wellesley, MA 02481-6216 - Phone
- (781) 205-0770
- NPI assigned
- Aug 18, 2019
- Organization subpart
- No
Authorized official
- Name
- Dr. Melissa Mae Burnett, MD
- Title
- Owner/Sole Manager
- Phone
- (781) 859-8157
Practitioners 6
-
Laura Archibald, M.D.
-
Jacqueline Moreau Kemp, MD, MS
-
Elissa J Lunder, MD
-
Virginia Ann Moye, MD, MPH
-
Kristen Rivard, ANP-BC, WHCNP-BC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 22D2316300 | Premier Dermatology, PLLC | Compliance | Apr 26, 2028 |
| 22D2330230 | Premier Dermatology | Provider-performed microscopy | Sep 11, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191120000122 | MA | Part B Supplier - Clinic/Group Practice | 8325470974 |
Receives reassigned benefits from 6 practitioners Practice locations: Wellesley, MA |
National Provider Directory
Locations
372 Washington St
Ste 2
Wellesley, MA 02481
Phone (781) 205-0770
372 Washington St
Ste 22
Wellesley Hills, MA 02481
372 Washington St
Ste 22NF
Wellesley Hills, MA 02481
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | Yes |
Addresses
Primary practice location
372 Washington St
2ND Floor
Wellesley, MA 02481-6216
Mailing address
563 North Ave
Weston, MA 02493-1839
Phone (781) 859-8157
Other providers in Wellesley, MA
- Theodore W Post
- Timothy Post
- Christina Potenza
- Pratt Medical Group, Inc
- Premier Dental Group of Wellesley, P.C.
- Premier Medical Associates
- Premier Vision Consultants, LLC
- Anhthy Trinh Prendeville
- Primary Care Pediatrics
- Alex T Prior
All providers in Wellesley, MA · Dermatology Physician in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 18, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.