Provider Demographics
NPI:1346331717
Name:PALMER, SUSAN M (DO)
Entity Type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:M
Last Name:PALMER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:714 ROUTE 10 W
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2058
Practice Address - Country:US
Practice Address - Phone:973-891-1213
Practice Address - Fax:973-891-1216
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05221700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ078149Medicare PIN
NJ078149Medicare ID - Type UnspecifiedMEDICARE NUMBER