Provider Demographics
NPI:1265447965
Name:LAHEY, EDWARD T III (MD, DMD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:T
Last Name:LAHEY
Suffix:III
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KNEELAND ST FL 5
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1529
Mailing Address - Country:US
Mailing Address - Phone:617-636-6515
Mailing Address - Fax:617-636-6809
Practice Address - Street 1:1 KNEELAND ST FL 5
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1529
Practice Address - Country:US
Practice Address - Phone:617-636-6515
Practice Address - Fax:617-636-6809
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN211571223S0112X
MA230038204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX09477OtherBLUE SHIELD