Provider Demographics
NPI:1689725079
Name:PALMER, SUSAN D (PA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:PALMER
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:41 MALL RD
Mailing Address - Street 2:LAHEY CLINIC, INC.
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-8420
Mailing Address - Fax:781-744-5429
Practice Address - Street 1:41 MALL RD
Practice Address - Street 2:LAHEY CLINIC, INC.
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-0001
Practice Address - Country:US
Practice Address - Phone:781-744-8420
Practice Address - Fax:781-744-5429
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2011-08-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA1635363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAP1961Medicare PIN
MAP93100Medicare UPIN