Individual
DR. SUSAN A VASSALLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
55 FRUIT ST, ANESTHESIA ASSOCIATES CLN 3, BOSTON, MA 02114-2621
(617) 724-3275
(617) 726-7536
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-3275
(617) 726-7536
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
56252
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056252
TUFTS HEALTH PLAN
MA
05
—
3052125
—
MA
01
—
J08720
BCBS MA
MA
Enumeration date
11/30/2005
Last updated
08/15/2012
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