1104921162 NPI number — NORTHEAST DERMATOLOGY ASSOCIATES, PC

Table of content: MS. MEGHAN LEIGH MCMILLAN LCSW (NPI 1538298302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104921162 NPI number — NORTHEAST DERMATOLOGY ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEAST DERMATOLOGY ASSOCIATES, PC
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:
1104921162
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
280 MERRIMACK STREET
Provider Second Line Business Mailing Address:
SUITE 311
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01843-1779
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-691-5690
Provider Business Mailing Address Fax Number:
978-691-5693

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
538 TURNPIKE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH ANDOVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-683-9201
Provider Business Practice Location Address Fax Number:
978-686-2770
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FINKLE
Authorized Official First Name:
JEREMY
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
978-691-5690

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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