Provider Demographics
NPI:1548689516
Name:WATERMAN, DYLAN ROSE (MD)
Entity type:Individual
Prefix:MS
First Name:DYLAN
Middle Name:ROSE
Last Name:WATERMAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:LAHEY HOSPITAL & MEDICAL CENTER
Mailing Address - Street 2:67 S. BEDFORD STREET
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-5108
Mailing Address - Country:US
Mailing Address - Phone:781-744-5115
Mailing Address - Fax:781-744-5687
Practice Address - Street 1:LAHEY HOSPITAL & MEDICAL CENTER
Practice Address - Street 2:67 S. BEDFORD STREET
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805
Practice Address - Country:US
Practice Address - Phone:781-744-5115
Practice Address - Fax:781-744-5687
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA274027207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology