Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 220128 | MA |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 220128 | MA |
NPI | 1639105240 |
---|---|
Provider Name | Dr. Susan T Mahan |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115-5724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 10/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2109417 | (05) | MA |
I39972 | (02) |