Provider Demographics
NPI:1275519787
Name:REY-ALVAREZ, SUSANA C (MD)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:C
Last Name:REY-ALVAREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 MILK ST, 9TH FLOOR
Mailing Address - Street 2:HARVARD VANGUARD MEDICAL ASSOCIATES
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4862
Mailing Address - Country:US
Mailing Address - Phone:617-559-8053
Mailing Address - Fax:617-421-3487
Practice Address - Street 1:20 WALL ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4758
Practice Address - Country:US
Practice Address - Phone:781-221-2500
Practice Address - Fax:781-221-2510
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39128208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0015922OtherNEIGHBORHOOD HEALTH
MA722556OtherTUFTS HEALTHCARE
MA12-04521OtherUNITED HEALTHCARE
MA4306351OtherCIGNA
MA3547308OtherAETNA
MA3014908Medicaid
MAAA8206OtherHARVARD PILGRIM
MAE05975OtherBLUE CROSS
MA0015922OtherNEIGHBORHOOD HEALTH
MA722556OtherTUFTS HEALTHCARE