Provider Demographics
NPI:1508169129
Name:BOSTON LASER SURGERY CENTER LLC
Entity Type:Organization
Organization Name:BOSTON LASER SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:A
Authorized Official - Last Name:MELKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-566-0062
Mailing Address - Street 1:1101 BEACON ST
Mailing Address - Street 2:SUITE 6W
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5587
Mailing Address - Country:US
Mailing Address - Phone:617-566-0062
Mailing Address - Fax:617-734-3264
Practice Address - Street 1:280 HAVERHILL ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1208
Practice Address - Country:US
Practice Address - Phone:978-685-5366
Practice Address - Fax:978-685-4867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4RIG261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical