Individual
EDWIN ISHOO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
ONE BROOKLINE PLACE, SUITE 321, BROOKLINE, MA 02445
(781) 552-6089
Mailing address
100 TRAPELO RD, APT 1, WALTHAM, MA 02452-6329
(781) 552-6089
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
154977
MA
207Y00000X
Otolaryngology Physician
2005-0084
NM
207YS0123X
Facial Plastic Surgery Physician
154977
MA
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Primary
154977
MA
207YX0602X
Otolaryngic Allergy Physician
MD2005-0084
NM
208200000X
Plastic Surgery Physician
154977
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2161133
—
MA
Enumeration date
07/30/2006
Last updated
09/23/2009
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