Provider Demographics
NPI:1184634834
Name:ELIAS, SUSAN C (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:ELIAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:41 MALL RD.
Mailing Address - Street 2:LAHEY CLINIC, INC.
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-8771
Mailing Address - Fax:781-744-2905
Practice Address - Street 1:1 ESSEX CENTER DR.
Practice Address - Street 2:LAHEY NORTHSHORE
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2901
Practice Address - Country:US
Practice Address - Phone:978-538-4300
Practice Address - Fax:978-538-4711
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-12-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH9478207R00000X
MA156289207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ19671Medicare PIN
G09702Medicare UPIN