Healthcare Provider Details

I. General information

NPI: 1407905961
Provider Name (Legal Business Name): GREATER METROWEST DERMSURGEONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 PROVIDENCE HWY
NORWOOD MA
02062
US

IV. Provider business mailing address

57 PROVIDENCE HWY
NORWOOD MA
02062-2645
US

V. Phone/Fax

Practice location:
  • Phone: 781-255-1900
  • Fax:
Mailing address:
  • Phone: 781-255-1900
  • Fax: 781-255-1909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DENNIS LEE
Title or Position: OWNER
Credential: M.D.
Phone: 781-255-1900