Provider Demographics
NPI:1609129956
Name:BROOKLINE DERMATOLOGY LLC
Entity Type:Organization
Organization Name:BROOKLINE DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-277-0800
Mailing Address - Street 1:235 CYPRESS ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6776
Mailing Address - Country:US
Mailing Address - Phone:617-277-0800
Mailing Address - Fax:617-277-0899
Practice Address - Street 1:235 CYPRESS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-6776
Practice Address - Country:US
Practice Address - Phone:617-277-0800
Practice Address - Fax:617-277-0899
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKLINE DERMATOLOGY ASSOCIATES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223638207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty