Individual
SUMA CHANDRA KANNABIRAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
55 LAKE AVENUE NORTH, DEPARTMENT OF RADIOLOGY, WORCESTER, MA 01655
(508) 334-1000
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
279413
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110134748A
—
MA
Enumeration date
04/22/2011
Last updated
05/26/2021
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