Healthcare Provider Details

I. General information

NPI: 1477558823
Provider Name (Legal Business Name): CHRISTOPHER LEBO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 GRAND ARMY HWY
SOMERSET MA
02726-1220
US

IV. Provider business mailing address

67 GRAND ARMY HWY
SOMERSET MA
02726-1220
US

V. Phone/Fax

Practice location:
  • Phone: 508-672-8117
  • Fax:
Mailing address:
  • Phone: 508-672-8117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number46961
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: