Provider Demographics
NPI:1265412571
Name:WANG, SUSAN S (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:S
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:31 HALL DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2751
Mailing Address - Country:US
Mailing Address - Phone:413-253-3773
Mailing Address - Fax:413-256-0215
Practice Address - Street 1:31 HALL DR
Practice Address - Street 2:SUITE 2
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2751
Practice Address - Country:US
Practice Address - Phone:413-253-3773
Practice Address - Fax:413-256-0215
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA216472208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA216472OtherCONNECTICARE
MA80603230323004OtherCIGNA
MAJ26555OtherBLUE CROSS AND BLUE SHIEL
MA0000000026060OtherBMC HEALTHNET
MA206220OtherHARVARD PILGRIM HEALTH CA
MA340154OtherTUFTS HEALTH PLAN
MA3154502OtherAETNA
MA32044OtherHEALTH NEW ENGLAND
MA45400OtherCHILDRENS MEDICAL SECURIT
MA2016681Medicaid
MA45400OtherCHILDRENS MEDICAL SECURIT
MA340154OtherTUFTS HEALTH PLAN