Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 21698 | MA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 21698 | MA |
NPI | 1295819217 |
---|---|
Provider Name | Mark A Lerman |
First Address | Boston, MA 02111-1527 |
Second Address | Boston, MA 02111-1527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 30/04/2020 |