Krushell, Jack

Krushell, Jack is an individual health care provider with primary practice located at 40 Holland St Dermatology Dept., Somerville MA 02144-2705. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Krushell, Jack can be contacted via phone (617) 629-6250.

Contact Information

Primary practice address
40 Holland St Dermatology Dept. Somerville MA 02144-2705
Fax: (617) 629-6108
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 74445 Massachusetts

Profile Details

NPI number 1558328609
LBN Legal business name Krushell, Jack
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 1st, 2006
Last updated Jan 25th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1558328609 NPPES
Massachusetts MEDICAID 3204545

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