1538500988 NPI number — SKIN WELLNESS PHYSICIANS, LLC

Table of content: MR. MOHAMMAD ALI SALEM PTA (NPI 1003150939)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538500988 NPI number — SKIN WELLNESS PHYSICIANS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SKIN WELLNESS PHYSICIANS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538500988
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
660 WASHINGTON ST
Provider Second Line Business Mailing Address:
APT 21H
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02111-3200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-872-4652
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 HERRICK ST
Provider Second Line Business Practice Location Address:
BEVERLY HOSPITAL ONCOLOGY CENTER
Provider Business Practice Location Address City Name:
BEVERLY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01915-1790
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-524-7933
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
REDDY
Authorized Official First Name:
KAVITHA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
617-872-4652

Provider Taxonomy Codes

  • Taxonomy code: 207NS0135X , with the licence number:  243807 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)