Provider Demographics
NPI:1235125980
Name:LIANG, SUSAN S
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:S
Last Name:LIANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 BAY ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-1085
Mailing Address - Country:US
Mailing Address - Phone:508-823-7473
Mailing Address - Fax:508-824-3830
Practice Address - Street 1:2005 BAY ST
Practice Address - Street 2:SUITE 201
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-1085
Practice Address - Country:US
Practice Address - Phone:508-823-7473
Practice Address - Fax:508-824-3830
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223991207W00000X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA36824OtherHARVARD PILGRIM HEALTH CA
MAJ29006OtherBCBS
MA2103931Medicaid
MA460300OtherTUFTS HEALTH PLAN
MAA38769Medicare ID - Type Unspecified
MA460300OtherTUFTS HEALTH PLAN