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NPI Code Detail

MEDICARE: DR. SUSAN BETH LANDRY DO

MEDICARE: DR. SUSAN BETH LANDRY DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician47484WI
2207Q00000XFamily Medicine Physician036-111312IL
3207Q00000XFamily Medicine Physician234300MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1234300OTHERMAMASS BORM LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134236680
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUSAN BETH LANDRY DO
Provider Business Mailing Address
First Line : 1 MONARCH PL
Second Line : 10TH FLOOR
City : SPRINGFIELD
State : MA
Zip : 01144-1099
Country : US
Telephone Number : 413-734-2000
Fax Number : 413-734-8000
Provider Business Practice Location Address
First Line : 1 MONARCH PL
Second Line : 10TH FLOOR
City : SPRINGFIELD
State : MA
Zip : 01144-1099
Country : US
Telephone Number : 413-734-2000
Fax Number : 413-734-8000
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2006
Last Update Date : 10/09/2013

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Directions to “ DR. SUSAN BETH LANDRY DO” Practice Location

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