Basic Information
| Provider Information | |||||||||
| NPI: | 1225327844 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEISS | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | LAHEY DERMATOLOGY | ||||||||
| Address2: | 67 S. BEDFORD ST., SUITE 100EAST | ||||||||
| City: | BURLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817445115 | ||||||||
| FaxNumber: | 7817445687 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 WALL ST | ||||||||
| Address2: | LAHEY HOSPITAL & MEDICAL CENTER AT WALL STREET | ||||||||
| City: | BURLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018034758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817445115 | ||||||||
| FaxNumber: | 7817445687 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2011 | ||||||||
| LastUpdateDate: | 03/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 262856 | MA | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.