Healthcare Provider Details

I. General information

NPI: 1053025742
Provider Name (Legal Business Name): BOSTON CENTER FOR FACIAL AESTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

287 MIDDLESEX AVE
MEDFORD MA
02155-5056
US

IV. Provider business mailing address

287 MIDDLESEX AVE
MEDFORD MA
02155-5056
US

V. Phone/Fax

Practice location:
  • Phone: 617-286-5780
  • Fax:
Mailing address:
  • Phone: 617-286-5780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY M OSBORN
Title or Position: OWNER
Credential: MD
Phone: 617-447-3980