Provider Demographics
NPI:1407905961
Name:GREATER METROWEST DERMSURGEONS, LLC
Entity Type:Organization
Organization Name:GREATER METROWEST DERMSURGEONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-255-1900
Mailing Address - Street 1:57 PROVIDENCE HWY
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-2645
Mailing Address - Country:US
Mailing Address - Phone:781-255-1900
Mailing Address - Fax:781-255-1909
Practice Address - Street 1:57 PROVIDENCE HWY
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062
Practice Address - Country:US
Practice Address - Phone:781-255-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM18974OtherBLUE CROSS GROUP
MA9752251Medicaid
MAM21698Medicare ID - Type UnspecifiedGROUP