Provider Demographics
NPI:1033192976
Name:SWEENEY, SUSAN M (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:526 MAIN ST STE 302
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3301
Mailing Address - Country:US
Mailing Address - Phone:978-371-7010
Mailing Address - Fax:978-371-0522
Practice Address - Street 1:95 WASHINGTON ST STE 210
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-4009
Practice Address - Country:US
Practice Address - Phone:781-713-1200
Practice Address - Fax:781-619-6202
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RI12933207N00000X
MA216892207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110034608AMedicaid
MAH87318Medicare UPIN
RI0011435Medicare PIN