Organization Name: | CRANBERRY SQUARE DERMATOLOGY PC |
NPI Number: | 1982829495 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | AMY BETH KOFF (OWNER) |
Mailing Address: | 434 Route 134 Suite 1a South Dennis |
State: | MA US |
Postal Code: | 026603433 |
Phone Number: | 5083945556 |
Fax Number: | 5083942735 |
NPI Enumeration Date: | 04/17/2007 |
NPI Last Update Date: | 08/28/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 80792 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |