Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 34393 | MA |
N | 208000000X | Pediatrician | 34393 | MA |
NPI | 1528058799 |
---|---|
Provider Name | Dr. Susan Perlmutter Pauker |
First Address | Somerville, MA 02144-2705 |
Second Address | Somerville, MA 02144-2705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 24/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3193951 | (05) | MA |