Individual
SUSAN G. BOLTON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
CCC-A
Contact information
Practice address
133 BROOKLINE AVE, BOSTON, MA 02215-3904
(617) 421-5984
Mailing address
147 MILK ST, PROVIDER ENROLLMENT - 9TH FLOOR, BOSTON, MA 02109-4806
(617) 559-8051
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
372
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0014864
NEIGHBORHOOD HEALTH PLAN
MA
05
—
5103045
—
MA
01
—
AD0164
BLUE CROSS
MA
01
—
B501027
CIGNA
MA
01
—
P00202945
MEDICARE RAILROAD
MA
01
—
PJ185
HARVARD PILGRIM
MA
Enumeration date
01/24/2006
Last updated
07/08/2007
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