Provider Demographics
NPI:1912598608
Name:MEDICAL LASER SOLUTIONS
Entity Type:Organization
Organization Name:MEDICAL LASER SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:508-930-7510
Mailing Address - Street 1:38 VANDERBILT AVE
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-5159
Mailing Address - Country:US
Mailing Address - Phone:781-762-2800
Mailing Address - Fax:
Practice Address - Street 1:38 VANDERBILT AVE
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-5159
Practice Address - Country:US
Practice Address - Phone:781-762-2800
Practice Address - Fax:781-762-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty