Provider Demographics
NPI:1942220371
Name:PURSELL, SUSAN E (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:PURSELL
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 1:480 MAPLE ST.
Mailing Address - Street 2:SUITE: 103
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923
Mailing Address - Country:US
Mailing Address - Phone:978-774-4400
Mailing Address - Fax:978-741-7742
Practice Address - Street 1:480 MAPLE ST
Practice Address - Street 2:SUITE: 103
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923
Practice Address - Country:US
Practice Address - Phone:978-774-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1511322088F0040X, 208800000X
MA18222088F0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2088F0040XAllopathic & Osteopathic PhysiciansUrologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3156842Medicaid
MAG31617Medicare UPIN
MAA21515Medicare PIN