Provider Demographics
NPI:1912966052
Name:CAMPOS, SUSANA MARIA (MD MPH)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:MARIA
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 BINNEY ST
Mailing Address - Street 2:DANA-FARBER CANCER INSTITUTE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-632-5269
Mailing Address - Fax:617-632-1930
Practice Address - Street 1:44 BINNEY ST
Practice Address - Street 2:DANA-FARBER CANCER INSTITUTE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-632-5269
Practice Address - Fax:617-632-1930
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81482207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
68577DFOtherHPHC DFCI ONLY
65521OtherFALLON COMMUNITY HEALTH P
3000507OtherUNITED HEALTH CARE
3184323OtherMASSHEALTH
MAJ19364OtherBCBS INDEMITY BC ELECT HM
2172306OtherAETNA US HEALTHCARE
6315500OtherCIGNA
081482OtherTUFTS
081482OtherTUFTS
68577DFOtherHPHC DFCI ONLY