Provider Demographics
NPI:1124037601
Name:CABOT, SUSAN T (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:T
Last Name:CABOT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:780 BOYLSTON ST
Mailing Address - Street 2:MEDICAL CARE AFFILIATES
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02199-7820
Mailing Address - Country:US
Mailing Address - Phone:617-262-1500
Mailing Address - Fax:617-262-7015
Practice Address - Street 1:780 BOYLSTON ST
Practice Address - Street 2:MEDICAL CARE AFFILIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02199-7820
Practice Address - Country:US
Practice Address - Phone:617-262-1500
Practice Address - Fax:617-262-7015
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80138207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3150577Medicaid
MA3150577Medicaid
MAJ30668Medicare ID - Type Unspecified