Provider Demographics
NPI:1770540486
Name:ROLAND, SUZANNE F (MD)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:F
Last Name:ROLAND
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPARTMENT - 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-421-2508
Mailing Address - Fax:617-421-3487
Practice Address - Street 1:133 BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3904
Practice Address - Country:US
Practice Address - Phone:617-421-1000
Practice Address - Fax:617-421-1000
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2012-01-05
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Provider Licenses
StateLicense IDTaxonomies
MA795762085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDAA6734OtherHARVARD PILGRIM
MA0802501OtherHEALTHSOURCE
MD0031939OtherNEIGHBORHOOD HEALTH
MD079576OtherTUFTS HEALTH PLAN
MDJ30581OtherB;IE CROSS BLUE SHIELD
MA0802501OtherCIGNA
MA3125688Medicare ID - Type Unspecified
MD0031939OtherNEIGHBORHOOD HEALTH
MD079576OtherTUFTS HEALTH PLAN