Healthcare Provider Details

I. General information

NPI: 1851860605
Provider Name (Legal Business Name): NESC - WIN-LAH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2018
Last Update Date: 11/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 VILLAGE SQUARE
CHELMSFORD MA
01824
US

IV. Provider business mailing address

27 VILLAGE SQUARE
CHELMSFORD MA
01824
US

V. Phone/Fax

Practice location:
  • Phone: 978-244-0060
  • Fax: 978-244-2522
Mailing address:
  • Phone: 978-244-0060
  • Fax: 978-244-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: HELEN RAYNHAM
Title or Position: MD/OWNER
Credential:
Phone: 978-244-0060