Healthcare Provider Details

I. General information

NPI: 1780945261
Provider Name (Legal Business Name): ELIZABETH BODDICKER LESTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 08/14/2023
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 PROSPECT ST
NASHUA NH
03060-3956
US

IV. Provider business mailing address

PO BOX 3677
NASHUA NH
03061-3677
US

V. Phone/Fax

Practice location:
  • Phone: 603-579-9648
  • Fax: 603-579-9647
Mailing address:
  • Phone: 603-577-7900
  • Fax: 603-577-7972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number19651
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number19651
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: