Provider Demographics
NPI:1053452268
Name:SUSAN AUERBACH, M.D., P.C.
Entity Type:Organization
Organization Name:SUSAN AUERBACH, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AUERBACH-FERDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-933-8060
Mailing Address - Street 1:18 COMMERCE WAY
Mailing Address - Street 2:SUITE 2650
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1051
Mailing Address - Country:US
Mailing Address - Phone:781-933-8060
Mailing Address - Fax:781-933-8067
Practice Address - Street 1:18 COMMERCE WAY
Practice Address - Street 2:SUITE 2650
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1051
Practice Address - Country:US
Practice Address - Phone:781-933-8060
Practice Address - Fax:781-933-8067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53943207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9730010Medicaid
MA9730010Medicaid