Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 53699 | MA |
NPI | 1023139276 |
---|---|
Provider Name | Ethan A Lerner |
First Address | Charlestown, MA 02129 |
Second Address | Charlestown, MA 02129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 08/07/2007 |