Provider Demographics
NPI:1558380717
Name:DAMIANI, SUZANNE MARIA (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIA
Last Name:DAMIANI
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 1:500 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1756
Mailing Address - Country:US
Mailing Address - Phone:978-557-8880
Mailing Address - Fax:978-557-8811
Practice Address - Street 1:500 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1756
Practice Address - Country:US
Practice Address - Phone:978-557-8880
Practice Address - Fax:978-557-8811
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA236195208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1558380717OtherANTHEM
MA95338501OtherNETWORK HEALTH
MAAA119100OtherHARVARD PILGRIM HEALTH CARE
MA110079875AMedicaid
MA1558380717OtherUNITED HEALTHCARE
MA3260515OtherCIGNA
MA1558380717OtherPHCS
MAJ43580OtherBCBS
MA0043844OtherNEIGHBORHOOD HEALTH PLAN
MA1558380717OtherBOSTON MEDICAL CENTER HEALTH PLAN
MA1558380717OtherFALLON COMMUNITY HEALTH PLAN
MA497839OtherTUFTS
MAAA119100OtherHPHC
MA1558380717OtherAETNA
NH30207813Medicaid
NH30207813Medicaid
MA1558380717OtherAETNA