MEDICARE: SUSAN E DONOHUE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	72980	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063493302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN E DONOHUE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 415348
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-5348
Country	:	US
Telephone Number	:	800-225-8885
Fax Number	:	508-334-1977

Provider Business Practice Location Address
First Line	:	157 UNION ST
Second Line	:
City	:	MARLBOROUGH
State	:	MA
Zip	:	01752-1228
Country	:	US
Telephone Number	:	508-486-6700
Fax Number	:	508-229-1227

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	10/27/2020

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