Provider Demographics
NPI:1518006006
Name:NOONAN, SUSAN J (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:NOONAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 WASHINGTON ST
Mailing Address - Street 2:#304
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-6464
Mailing Address - Country:US
Mailing Address - Phone:781-431-9620
Mailing Address - Fax:
Practice Address - Street 1:609 WASHINGTON ST
Practice Address - Street 2:#304
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-6464
Practice Address - Country:US
Practice Address - Phone:781-431-9620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA512952083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine