Provider Demographics
NPI:1487638003
Name:MAGEE, SUSANNA R (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSANNA
Middle Name:R
Last Name:MAGEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 BREWSTER ST
Mailing Address - Street 2:WOOD BLDG 516
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4400
Mailing Address - Country:US
Mailing Address - Phone:401-729-3481
Mailing Address - Fax:401-729-2721
Practice Address - Street 1:111 BREWSTER ST
Practice Address - Street 2:FAMILY CARE CENTER
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4400
Practice Address - Country:US
Practice Address - Phone:401-729-2206
Practice Address - Fax:401-729-3495
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD10534207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007061049OtherMEDICARE PTAN
RI7009042Medicaid
RI7009042Medicaid