Provider Demographics
NPI:1073509741
Name:ROWE, SUSANNAH G (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSANNAH
Middle Name:G
Last Name:ROWE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 BAY ST STE 206
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-1085
Mailing Address - Country:US
Mailing Address - Phone:508-823-7473
Mailing Address - Fax:508-824-3830
Practice Address - Street 1:2005 BAY ST STE 206
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-1085
Practice Address - Country:US
Practice Address - Phone:508-823-7473
Practice Address - Fax:508-824-3830
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA153735207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ21629OtherBCBS
MA152181BMCOtherHARVARD PILGRIM HEALTH CA
MA3199029Medicaid
MA153735OtherTUFTS HEALTH PLAN
MA2202021OtherAETNA
MA2202021OtherAETNA
MAJ21629Medicare PIN
MAG80650Medicare UPIN
MA152181BMCOtherHARVARD PILGRIM HEALTH CA