Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 153315 | MA |
N | 111NI0900X | Internist | 153315 | MA |
Y | 207RG0300X | Geriatric Medicine | 153315 | MA |
NPI | 1063495943 |
---|---|
Provider Name | Dr. Suhasini R Iyer |
First Address | Boston, MA 02241 |
Second Address | Worcester, MA 01605-2903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2005 |
Last Update Date | 23/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3173526 | (05) | MA |
G59820 | (02) | MA |