ID OF MASSACHUSETTS LLC
NPI 1477229326
Dermatology in Quincy, MA

Q: What is Id Of Massachusetts LLC's NPI number?

The NPI number for Id Of Massachusetts LLC is 1477229326. It was assigned to this organization in the NPPES registry on August 20, 2021.

Q: What is Id Of Massachusetts LLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Active since August 20, 2021

104 QUARRY ST STE 2, QUINCY, MA 02169(617) 472-6764(617) 770-9933 Get Directions Write a Review

NPPES record last updated: January 27, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jan 27, 2026, Aug 20, 2021 (2 updates tracked since 2021).

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About Id Of Massachusetts Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ID OF MASSACHUSETTS LLC (NPI 1477229326) is a healthcare organization registered as a dermatology in Quincy, Massachusetts and active in the NPI registry since August 2021. The organization maintains a secondary practice location in Plymouth and lists Jennifer L Jackson, Authorized Official, as its authorized official.

NPPES Registry Identity

NPI1477229326

Entity TypeOrganization

Primary Taxonomy207N00000X

Legal Business NameID OF MASSACHUSETTS LLC

Location Address104 QUARRY ST STE 2Quincy, MA 02169-4174

Mailing Address4700 Exchange Ct Ste 110Boca Raton, FL 33431-4450 · (561) 314-2000

Phone(617) 472-6764

Fax(617) 770-9933

Organization SubpartNo

Authorized OfficialJennifer L JacksonAuthorized Official · (561) 223-8081

Enumeration DateAugust 20, 2021

Last NPPES UpdateJanuary 27, 20262 updates tracked since enumeration

NPPES CertifiedJanuary 27, 2026

✔ NPI 1477229326 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians

Taxonomy Code207N00000X

Definition

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

104 QUARRY ST STE 2, Quincy, MA 02169

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Secondary Practice Location 1

Location 140 Industrial Park Rd Ste 202Plymouth, MA 02360-4884 · Phone (617) 472-6764 · Fax (617) 770-9933

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. KRISTINA MARIE ANDERSON F.N.P.-C

Nurse Practitioner (Family)