Provider Demographics
NPI:1154398964
Name:CHI, SUSAN N (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:N
Last Name:CHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 BINNEY ST
Mailing Address - Street 2:ROOM SW 331
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-632-4142
Mailing Address - Fax:617-632-4897
Practice Address - Street 1:44 BINNEY ST
Practice Address - Street 2:ROOM SW 331
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-632-4142
Practice Address - Fax:617-632-4897
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2164662080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
216466OtherTUFTS
80291OtherFALLON COMMUNITY HEALTH P
MAJ25786OtherBLUE CROSS BLUE SHIELD
9673117OtherCIGNA
MA2003660Medicaid
206175OtherHPHC DFCI ONLY
MA2003660Medicaid
216466OtherTUFTS