Provider Demographics
NPI:1730143702
Name:TREDWELL, SUSAN PRESTON (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:PRESTON
Last Name:TREDWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT STREET YAW 4 E
Practice Address - Street 2:VINCENT OBGYN SERVICE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-724-6850
Practice Address - Fax:617-724-5843
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA58651207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA317509OtherBCBS MA
MA3164811Medicaid
MA726460OtherTUFTS HEALTH PLAN
MA317509OtherBCBS MA
E72844Medicare UPIN