Individual
TATIANA SUVOROV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
CHA REVERE FAMILY CARE CENTER, 454 BROADWAY, REVERE, MA 02151
(781) 485-8222
Mailing address
CAMBRIDGE HEALTH ALLIANCE, 1493 CAMBRIDGE STREET, CAMBRIDGE, MA 02139
(617) 665-1000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
015788
NY
363AM0700X
Medical Physician Assistant
Primary
PA6778
MA
Other
Enumeration date
09/05/2012
Last updated
06/13/2019
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