Provider Demographics
NPI:1942293261
Name:CHABOT, SUSAN MARIE (MD)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARIE
Last Name:CHABOT
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 1:62 BROWN ST
Mailing Address - Street 2:SUITE 507
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6778
Mailing Address - Country:US
Mailing Address - Phone:781-769-4660
Mailing Address - Fax:781-769-0371
Practice Address - Street 1:825 WASHINGTON STREET
Practice Address - Street 2:SUITE 240
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3441
Practice Address - Country:US
Practice Address - Phone:781-769-4660
Practice Address - Fax:781-769-0371
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA58767207X00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3095240Medicaid
MD17579OtherHARVARD PILGRIM
MA200012745OtherRR MEDICARE
MA058767OtherTUFTS
MAJ12534OtherBLUE CROSS/BLUE SHIELD
MA200012745OtherRR MEDICARE
MA3095240Medicaid