Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 257940 | MA |
NPI | 1003136771 |
---|---|
Provider Name | Erica Dommasch |
First Address | Boston, MA 02215-5400 |
Second Address | Boston, MA 02215-5400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2010 |
Last Update Date | 20/03/2015 |