NPIMap

Organization Active NPI

Nedan LLC

  • Dermatology Physician
  • North Andover, MA
National Provider Identifier
1669844163
Registry record updated Oct 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
NEDAN LLC
Practice address
538 Turnpike St
North Andover, MA 01845-5812
Phone
(978) 691-5690
Fax
(978) 691-5693
NPI assigned
Oct 22, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2024

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

Authorized official

Name
Kathleen Mathison-Reynolds
Title
Credentialing Manager
Phone
(937) 241-5930

Specialties & licenses 1

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

Addresses

Primary practice location

538 Turnpike St
North Andover, MA 01845-5812

Mailing address

280 Merrimack St Ste 311
Lawrence, MA 01843-1779
Phone (978) 691-5690

Other practice location 1

198 Massachusetts Ave Ste 105
North Andover, MA 01845-4143
Phone (978) 691-5690

Other practice location 2

138 Conant St
Beverly, MA 01915-1665
Phone (978) 691-5690

Other practice location 3

1 Blackburn Dr
Gloucester, MA 01930-2292
Phone (978) 691-5690

Other practice location 4

62 Brown St Ste 304C
Haverhill, MA 01830-6790
Phone (978) 691-5690

Other practice location 5

1 Wallace Bashaw Way Ste 1002
Newburyport, MA 01950-3876
Phone (978) 691-5690

Other names 1

  • NORTHEAST DERMATOLOGY ASSOCIATES Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040317000655 MA Part B Supplier - Clinic/Group Practice 3072403799 Receives reassigned benefits from 70 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: North Falmouth, MA; West Roxbury, MA; Swansea, MA; Salem, MA; Plymouth, MA; Norwell, MA; North Andover, MA; Newburyport, MA…
O20180122000100 MA Part B Supplier - Clinic/Group Practice 6002175007 Receives reassigned benefits from 1 practitioner
Practice locations: Lawrence, MA

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

62 Brown St
Ste 304G
Haverhill, MA 01830

198 Massachusetts Ave
Ste 203
North Andover, MA 01845

5 Paradise Rd
Salem, MA 01970
Phone (978) 306-5678

Practitioners & affiliated clinicians

Practitioners 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1445472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729641600000",
    "number": "1669844163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 MERRIMACK ST STE 311",
            "city": "LAWRENCE",
            "state": "MA",
            "postal_code": "018431779",
            "telephone_number": "978-691-5690",
            "fax_number": "978-691-5693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "538 TURNPIKE ST",
            "city": "NORTH ANDOVER",
            "state": "MA",
            "postal_code": "018455812",
            "telephone_number": "978-691-5690",
            "fax_number": "978-691-5693"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "198 Massachusetts Ave Ste 105",
            "address_purpose": "LOCATION",
            "city": "North Andover",
            "state": "MA",
            "postal_code": "018454143",
            "country_code": "US",
            "telephone_number": "978-691-5690",
            "fax_number": "978-691-5693",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "138 Conant St",
            "address_purpose": "LOCATION",
            "city": "Beverly",
            "state": "MA",
            "postal_code": "019151665",
            "country_code": "US",
            "telephone_number": "978-691-5690",
            "fax_number": "978-691-5693",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Blackburn Dr",
            "address_purpose": "LOCATION",
            "city": "Gloucester",
            "state": "MA",
            "postal_code": "019302292",
            "country_code": "US",
            "telephone_number": "978-691-5690",
            "fax_number": "978-691-5693",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "62 Brown St Ste 304C",
            "address_purpose": "LOCATION",
            "city": "Haverhill",
            "state": "MA",
            "postal_code": "018306790",
            "country_code": "US",
            "telephone_number": "978-691-5690",
            "fax_number": "978-691-5693",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Wallace Bashaw Way Ste 1002",
            "address_purpose": "LOCATION",
            "city": "Newburyport",
            "state": "MA",
            "postal_code": "019503876",
            "country_code": "US",
            "telephone_number": "978-691-5690",
            "fax_number": "978-691-5693",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NEDAN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-22",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-23",
        "status": "A",
        "authorized_official_last_name": "MATHISON-REYNOLDS",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "937-241-5930"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTHEAST DERMATOLOGY ASSOCIATES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Andover, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2024; 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.