Healthcare Provider Details

I. General information

NPI: 1083693485
Provider Name (Legal Business Name): JAMES N SUOJANEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FOGG RD
SOUTH WEYMOUTH MA
02190-2432
US

IV. Provider business mailing address

PO BOX 1079
LEWISTON ME
04243-1079
US

V. Phone/Fax

Practice location:
  • Phone: 781-337-7011
  • Fax:
Mailing address:
  • Phone: 800-456-1552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number57939
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: