Provider Demographics
NPI:1417096900
Name:WITKIE, SUSAN M (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:WITKIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:6 WHITTIER PL
Mailing Address - Street 2:APT. NO. 17-N
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-1443
Mailing Address - Country:US
Mailing Address - Phone:617-654-7710
Mailing Address - Fax:
Practice Address - Street 1:6 WHITTIER PL
Practice Address - Street 2:APT #17-N
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-1443
Practice Address - Country:US
Practice Address - Phone:617-654-7710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA490702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry