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General NPI Number Information
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NPI Number | 1336477249
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Entity Type | Individual
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Provider Name | ANDREI METELITSA M.D., FRCPC
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Gender | Male
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Dates
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Enumeration Date | 12/04/2009
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Last Update Date | 06/23/2010
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Provider Practice Location Address
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Address Line | 1244 BOYLSTON ST
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City | CHESTNUT HILL
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State | MA
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Zip | 02467-2116
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Country | US
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Telephone | 617-731-1600
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Fax | 617-731-1601
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Provider Business Mailing Address
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Address Line | 1244 BOYLSTON ST
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City | CHESTNUT HILL
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State | MA
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Zip | 02467-2116
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Country | US
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Telephone | 617-731-1600
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Fax | 617-731-1601
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 242957
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License Number State | MA
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