Healthcare Provider Details

I. General information

NPI: 1871354803
Provider Name (Legal Business Name): GREATER BOSTON DERMATOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 LINCOLN ST
FRAMINGHAM MA
01702-8200
US

IV. Provider business mailing address

PO BOX 600736
NEWTONVILLE MA
02460-0007
US

V. Phone/Fax

Practice location:
  • Phone: 617-540-5570
  • Fax: 617-540-5571
Mailing address:
  • Phone: 617-540-5571
  • Fax: 617-540-5571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. REBECCA KHEZRI JACOBSON
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 508-719-8947