Organization
BRIGHAM AND WOMENS PHYSICIANS ORGANIZATION INC
Active
Other names
dba Dept of Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM C JOHNSTON (CFO)
(617) 713-2263
Entity
Organization
Contact information
Practice address
221 LONGWOOD AVE, BOSTON, MA 02115-5804
(617) 732-4918
Mailing address
111 CYPRESS ST, BROOKLINE, MA 02445-6002
(617) 582-1200
(617) 713-2283
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207ND0900X
Dermatopathology Physician
—
—
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9702610
—
MA
01
—
M17625
BCBS DERM GRP #
MA
Enumeration date
07/08/2006
Last updated
04/07/2011
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