Provider Demographics
NPI:1114512035
Name:RAJ, SUZANNE BURSTEIN (RN)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:BURSTEIN
Last Name:RAJ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:L
Other - Last Name:BURSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER-F
Mailing Address - Street 1:215 ALEWIFE BROOK PKWY
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1101
Mailing Address - Country:US
Mailing Address - Phone:617-661-6422
Mailing Address - Fax:
Practice Address - Street 1:215 ALEWIFE BROOK PKWY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1101
Practice Address - Country:US
Practice Address - Phone:617-661-6422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2287176363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily