Provider Demographics
NPI:1164581856
Name:DELUCA, SUSAN M (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:DELUCA
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Gender:F
Credentials:MD
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Mailing Address - Street 1:900 CUMMINGS CTR
Mailing Address - Street 2:SUITE 126V
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6198
Mailing Address - Country:US
Mailing Address - Phone:978-279-0800
Mailing Address - Fax:978-279-0805
Practice Address - Street 1:900 CUMMINGS CTR
Practice Address - Street 2:SUITE 126V
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6198
Practice Address - Country:US
Practice Address - Phone:978-279-0800
Practice Address - Fax:978-279-0805
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2011-10-05
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Provider Licenses
StateLicense IDTaxonomies
MA79174207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F96391Medicare UPIN
J30974Medicare ID - Type Unspecified