Provider Demographics
NPI:1831684224
Name:LERTPHANICHKUL, CHOTINIJ (MD)
Entity type:Individual
Prefix:DR
First Name:CHOTINIJ
Middle Name:
Last Name:LERTPHANICHKUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 EMERSON PL APT 3J
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2218
Mailing Address - Country:US
Mailing Address - Phone:617-320-8748
Mailing Address - Fax:
Practice Address - Street 1:850 BOYLSTON ST STE 437
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2405
Practice Address - Country:US
Practice Address - Phone:617-732-9090
Practice Address - Fax:917-232-1043
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA274825207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology