MEDICARE: DR. SUSAN A ABOOKIRE MD

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	207R00000X	Internal Medicine Physician	77587	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	077587	OTHER	MA	TUFTS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	J14393	OTHER	MA	BLUE CROSS
4	AA30856	OTHER	MA	HARVARD PILGRIM

General Provider Information

NPI Number	:	1407859762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN A ABOOKIRE MD

Provider Business Mailing Address
First Line	:	330 MOUNT AUBURN ST
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02138-5502
Country	:	US
Telephone Number	:	617-575-8603
Fax Number	:	617-499-5575

Provider Business Practice Location Address
First Line	:	330 MOUNT AUBURN ST
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02138-5502
Country	:	US
Telephone Number	:	617-575-8603
Fax Number	:	617-499-5575

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/08/2007

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