Healthcare Provider Details

I. General information

NPI: 1629008115
Provider Name (Legal Business Name): JEFFREY SUSSMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 CAREW ST NEW ENGLAND PATHOLOGY ASSOCIATES PC
SPRINGFIELD MA
01104
US

IV. Provider business mailing address

PO BOX 789
LUDLOW MA
01056-0789
US

V. Phone/Fax

Practice location:
  • Phone: 413-748-9513
  • Fax: 413-748-6844
Mailing address:
  • Phone: 413-509-1000
  • Fax: 413-509-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number73526
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number73526
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: