Healthcare Provider Details

I. General information

NPI: 1952662710
Provider Name (Legal Business Name): SUSAN CHOE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 10/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LAHEY OUTPATIENT CENTER @ DANVERS 480 MAPLE STREET 1ST FL
DANVERS MA
01923
US

IV. Provider business mailing address

PROVIDER ENROLLMENT DEPT. LAHEY CLINIC INC 41 MALL ROAD
BURLINGTON MA
01805-0001
US

V. Phone/Fax

Practice location:
  • Phone: 978-304-8360
  • Fax:
Mailing address:
  • Phone: 781-744-8085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number272770
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: