Provider Demographics
NPI:1871833293
Name:DR. SUSAN PORIES
Entity Type:Organization
Organization Name:DR. SUSAN PORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:PORIES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-576-3350
Mailing Address - Street 1:300 MOUNT AUBURN ST
Mailing Address - Street 2:DOB 509
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5600
Mailing Address - Country:US
Mailing Address - Phone:617-576-3350
Mailing Address - Fax:617-576-6422
Practice Address - Street 1:300 MOUNT AUBURN ST
Practice Address - Street 2:DOB 509
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5600
Practice Address - Country:US
Practice Address - Phone:617-576-3350
Practice Address - Fax:617-576-6422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71236305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAE84782Medicare UPIN