Individual
MS. SU LUO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
67 S BEDFORD ST, BURLINGTON, MA 01803-5108
(781) 744-8000
Mailing address
19 BELLE ISLE WAY, CRANSTON, RI 02921-3542
(401) 527-5207
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
MD15425
RI
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
266195
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
207N00000X
MEDICARE 855O
MA
Enumeration date
04/04/2011
Last updated
10/05/2020
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