Provider Demographics
NPI:1093159477
Name:EDAPPALLATH, SUSMITHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSMITHA
Middle Name:
Last Name:EDAPPALLATH
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 1:3053 GUILFORD AVE
Mailing Address - Street 2:APARTMENT #2
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-3926
Mailing Address - Country:US
Mailing Address - Phone:412-596-7828
Mailing Address - Fax:
Practice Address - Street 1:BAYSTATE MEDICAL CTR
Practice Address - Street 2:759 CHESTNUT STREET
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01199-0001
Practice Address - Country:US
Practice Address - Phone:413-794-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program