Individual
DR. SUSAN M DUSENBERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
133 BROOKLINE AVE, BOSTON, MA 02215-3904
(617) 513-6711
Mailing address
133 BROOKLINE AVE, BOSTON, MA 02215-3904
(617) 513-6711
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
20070111894
MO
2080P0202X
Pediatric Cardiology Physician
Primary
253317
MA
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
20070111894
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110095100A
—
MA
05
—
207231408
—
MO
Enumeration date
05/02/2007
Last updated
10/02/2013
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