MEDICARE: DR. WALTER SUSSMAN D.O.

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	208100000X	Physical Medicine & Rehabilitation Physician	073846	GA
2	208100000X	Physical Medicine & Rehabilitation Physician	265681	MA

General Provider Information

NPI Number	:	1538457684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALTER SUSSMAN D.O.

Provider Business Mailing Address
First Line	:	35 UNITED DR STE 102
Second Line	:
City	:	WEST BRIDGEWATER
State	:	MA
Zip	:	02379-1056
Country	:	US
Telephone Number	:	508-238-8646
Fax Number	:	508-230-9772

Provider Business Practice Location Address
First Line	:	20 WALNUT ST STE 14
Second Line	:
City	:	WELLESLEY
State	:	MA
Zip	:	02481-2104
Country	:	US
Telephone Number	:	781-591-7855
Fax Number	:	781-591-7854

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

Provider Enumeration Date	:	07/11/2011
Last Update Date	:	05/25/2021

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