=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619110145
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUZANA MARIA ZORCA M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2009
-----------------------------------------------------
Last Update Date | 08/11/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 VFW PARKWAY BUILDING 1 SUITE 3C-102 VHA BOSTON HEALTHCARE SYSTEM
-----------------------------------------------------
City | WEST ROXBURY-
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02132-6110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-960-7592
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1166 EAST ST
-----------------------------------------------------
City | DEDHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02026-6119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-960-7592
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 254988
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------