Active NPI
Mia Alyse Mologousis
- Dermatology Physician
- Boston, MA
National Provider Identifier
1700589884
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 3017989
- Practice address
- 800 Washington St
Boston, MA 02111-1552 - Phone
- (617) 636-5000
- NPI assigned
- Mar 27, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 3017989 | MA | Primary |
Addresses
Primary practice location
800 Washington St
Boston, MA 02111-1552
Mailing address
8027 Savoy Club CT
Burr Ridge, IL 60527
Phone (630) 991-7500
Other practice location 1
7435 W Talcott Avenue
Chicago, IL 60631
Phone (773) 990-5261
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3017989 | MA | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747785600000",
"number": "1700589884",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8027 SAVOY CLUB CT",
"city": "BURR RIDGE",
"state": "IL",
"postal_code": "60527",
"telephone_number": "630-991-7500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 WASHINGTON ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021111552",
"telephone_number": "617-636-5000"
}
],
"practiceLocations": [
{
"address_1": "7435 W Talcott Avenue",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "60631",
"country_code": "US",
"telephone_number": "773-990-5261",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MOLOGOUSIS",
"first_name": "MIA",
"middle_name": "ALYSE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-27",
"last_updated": "2025-05-21",
"certification_date": "2025-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "MA",
"license": "3017989",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.