Healthcare Provider Details

I. General information

NPI: 1902843568
Provider Name (Legal Business Name): SUSAN DAVIDSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PARKER HILL AVE
ROXBURY CROSSING MA
02120-2847
US

IV. Provider business mailing address

PO BOX 67387
CHESTNUT HILL MA
02467-0004
US

V. Phone/Fax

Practice location:
  • Phone: 617-738-9600
  • Fax:
Mailing address:
  • Phone: 617-738-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number54631
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: