Healthcare Provider Details

I. General information

NPI: 1811982614
Provider Name (Legal Business Name): SUSANNAH KAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 EAST ST
METHUEN MA
01844-4597
US

IV. Provider business mailing address

366 ESTABROOK RD
CONCORD MA
01742-5615
US

V. Phone/Fax

Practice location:
  • Phone: 978-982-3004
  • Fax:
Mailing address:
  • Phone: 800-927-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number207923
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number207923
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: