Basic Information
Provider Information
NPI: 1619003324
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARON
FirstName: SUZANNE
MiddleName: JANE
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: LAHEY PROVIDER ENROLLMENT DEPARTMENT
Address2: 41 MALL ROAD
City: BURLINGTON
State: MA
PostalCode: 01805
CountryCode: US
TelephoneNumber: 7817448085
FaxNumber: 7817445433
Practice Location
Address1: LAHEY HOSPITAL AND MEDICAL CENTER
Address2: 41 MALL ROAD
City: BURLINGTON
State: MA
PostalCode: 01805
CountryCode: US
TelephoneNumber: 7817448000
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/26/2007
LastUpdateDate: 07/16/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0011X234326MAY Allopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology

No ID Information.


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