Individual
JAIMIE DEROSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
91 NEWBURY ST, SUITE 300, BOSTON, MA 02116-3084
(617) 262-8000
(617) 262-8002
Mailing address
91 NEWBURY ST, SUITE 300, BOSTON, MA 02116-3084
(617) 262-8000
(617) 262-8002
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
237016
MA
207YS0123X
Facial Plastic Surgery Physician
Primary
237016
MA
Other
Enumeration date
06/05/2006
Last updated
05/24/2013
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