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General NPI Number Information
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NPI Number | 1215963574
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Entity Type | Organization
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Legal Business Name | BOSTON DERMATOLOGY AND LASER CENTER, LLC
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 30 LANCASTER STREET SUITE 400
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City | BOSTON
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State | MA
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Zip | 02114-2517
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Country | US
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Telephone | 617-722-4100
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Fax | 617-227-1134
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Provider Business Mailing Address
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Address Line | 526 MAIN ST STE 302
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City | ACTON
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State | MA
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Zip | 01720-3301
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Country | US
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Telephone | 978-371-7010
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Fax | 978-371-0522
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Authorized Official
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Title or Position | OWNER/MANAGING PARTNER
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Name | SAMUEL GOOS
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Credential | MD
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Telephone | 978-371-7010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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