Dermwellesley LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

254256 Issued in MA

Legal business name

DERMWELLESLEY LLC

Practice address

20 William St
Wellesley, MA 02481-4103

Phone

(781) 591-4234

Fax

(781) 369-9737

NPI assigned

Aug 24, 2018

Last updated

Jan 3, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Emily Wise, MDNPI 1487882270

Title

Owner

Phone

(857) 317-2057

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Emily Michelle Wise, MD

  • Dermatology Physician
  • Wellesley, MA
  • NPI 1487882270

  Single Specialty

  Medicare reassignment Care Compare group NPD Authorized official
• Sara Alison Berg, MD

  • Dermatology Physician
  • Wellesley, MA
  • NPI 1750776712
  Medicare reassignment Care Compare group NPD
• Alison Callahan, MD

  • Ophthalmology Physician
  • Boston, MA
  • NPI 1992016059
  Medicare reassignment Care Compare group NPD
• Caren Droesch, M.D.

  • Dermatology Physician
  • Wellesley, MA
  • NPI 1396193777
  Medicare reassignment Care Compare group NPD
• Jacqueline Greb Goldminz, MD

  • Dermatology Physician
  • Wellesley, MA
  • NPI 1215466719
  Medicare reassignment Care Compare group NPD
• Julia Marvel, NP

  • Primary Care Nurse Practitioner
  • Waltham, MA
  • NPI 1003572413

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• Barbara Ann Stjohn, N.P.

  • Primary Care Nurse Practitioner
  • Wellesley, MA
  • NPI 1275886285
  Medicare reassignment Care Compare group NPD
• Tiffany Sun, M.D. PH.D.

  • MOHS-Micrographic Surgery Physician
  • Burlington, MA
  • NPI 1245620921

  Dermatology

  Medicare reassignment Care Compare group NPD
• Mariko Yasuda, M.D.

  • Dermatology Physician
  • Worcester, MA
  • NPI 1073741385
  Medicare reassignment Care Compare group NPD
• Lindsay McCormack, MD

  • Dermatology Physician
  • Wellesley, MA
  • NPI 1831765148
  NPD

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

{
    "created_epoch": "1535068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546473600000",
    "number": "1811478092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 WILLIAM ST",
            "city": "WELLESLEY",
            "state": "MA",
            "postal_code": "024814103",
            "telephone_number": "781-591-4234",
            "fax_number": "857-317-2811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 WILLIAM ST",
            "city": "WELLESLEY",
            "state": "MA",
            "postal_code": "024814103",
            "telephone_number": "781-591-4234",
            "fax_number": "781-369-9737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMWELLESLEY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-24",
        "last_updated": "2019-01-03",
        "status": "A",
        "authorized_official_last_name": "WISE",
        "authorized_official_first_name": "EMILY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "857-317-2057",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "MA",
            "license": "254256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dermatology & Skin Care Assoc PC
• Dermatology and Skin Care Associates LLC
• Dermatology Specialists of Wellesley PC
• Dermpath New England, LLC
• Dermpath New England, LLC
• Vincent Desantis, M.D.
• Laura Winchelle Desir, OTR/L
• Judy Destefano
• Justin Dichio, PT, DPT
• Gerald Dimatteo, LICSW

• Dermatology Physician in Wellesley, MA
• Providers in Wellesley, MA by specialty
• Dermatology Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.