Basic Information
| Provider Information | |||||||||
| NPI: | 1407019854 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACKAY | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 143 LONGWATER DR | ||||||||
| Address2: | |||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020611683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818785200 | ||||||||
| FaxNumber: | 7818786750 | ||||||||
| Practice Location | |||||||||
| Address1: | 143 LONGWATER DR | ||||||||
| Address2: | |||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020611683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818785200 | ||||||||
| FaxNumber: | 7818786750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2008 | ||||||||
| LastUpdateDate: | 12/21/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 250239 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1407019854 | 01 | FALLON | OTHER | 278984 | 01 | TUFTS AND TMP | OTHER | 4801073 | 01 | CIGNA | OTHER | 110094237A | 05 | MA | MEDICAID | 042297845 | 01 | UNITED HEALTH CARE | OTHER | 1407019854 | 01 | NHP | OTHER | 921778 | 01 | AETNA | OTHER | AA290613 | 01 | HARVARD PILGRIM | OTHER | 042297845 | 01 | PHCS | OTHER | J50272 | 01 | MA | BCBSMA | OTHER | 042297845 | 01 | HCVM | OTHER | 1407019854 | 01 | NEIGHBORHOOD HEALTH PLAN | OTHER | 042297845 | 01 | TRICARE | OTHER | 042297845 | 01 | GIC/UNICARE | OTHER |