Modern Dermatology of Massachusetts, PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

MODERN DERMATOLOGY OF MASSACHUSETTS, PLLC

Practice address

10 N Main St Ste 402
Fall River, MA 02720-2130

Phone

(508) 974-3037

Fax

(434) 423-4783

NPI assigned

Nov 20, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Erik Domingues, MDNPI 1962713370

Title

Dermatologist

Phone

(508) 974-3037

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Locations

Practitioners 2

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

• Erik Domingues, MD

  • Dermatology Physician
  • Fall River, MA
  • NPI 1962713370
  Medicare reassignment Care Compare group NPD Authorized official
• Jessica Lynn Runquist, PA-C

  • Physician Assistant
  • Swansea, MA
  • NPI 1124557376
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1700438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705708800000",
    "number": "1831964915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 LAMBERT LN",
            "city": "WARREN",
            "state": "RI",
            "postal_code": "028851639",
            "telephone_number": "508-974-3037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 N MAIN ST STE 402",
            "city": "FALL RIVER",
            "state": "MA",
            "postal_code": "027202130",
            "telephone_number": "508-974-3037",
            "fax_number": "434-423-4783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DERMATOLOGY OF MASSACHUSETTS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-20",
        "last_updated": "2024-01-20",
        "certification_date": "2024-01-20",
        "status": "A",
        "authorized_official_last_name": "DOMINGUES",
        "authorized_official_first_name": "ERIK",
        "authorized_official_title_or_position": "DERMATOLOGIST",
        "authorized_official_telephone_number": "508-974-3037",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grace M. Mitchell
• John R Mitchell, LICSW
• Susan Anne Mitchell, LICSW
• Jessica Mkpanam, MSW
• Mikyong Mobilia, CPNP-PC
• Elisabeth Karen Modestino, LICSW
• Elizabeth Modiclan
• Carla Moe, LICSW
• Patricia Moisan
• Gerald J Monchik, MD

• Dermatology Physician in Fall River, MA
• Providers in Fall River, 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 20, 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.