Healthcare Provider Details

I. General information

NPI: 1932574274
Provider Name (Legal Business Name): CARLOS SUAREZ, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2015
Last Update Date: 12/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 COMMONWEALTH AVE SUITE 906
BOSTON MA
02116-2349
US

IV. Provider business mailing address

29 COMMONWEALTH AVE SUITE 906
BOSTON MA
02116-2349
US

V. Phone/Fax

Practice location:
  • Phone: 617-992-6256
  • Fax: 781-219-4200
Mailing address:
  • Phone: 617-992-6256
  • Fax: 781-219-4200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number236475
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number236475
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number236475
License Number StateMA

VIII. Authorized Official

Name: DR. CARLOS SUAREZ
Title or Position: PSYCHIATRIST
Credential: M.D.
Phone: 617-992-6256