Provider Demographics
NPI:1316524804
Name:WASHBURN, SUSAN FLAHERTY (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:FLAHERTY
Last Name:WASHBURN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:FLAHERTY
Other - Last Name:KOSTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:357 HARTFORD TPKE
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4838
Mailing Address - Country:US
Mailing Address - Phone:860-871-2102
Mailing Address - Fax:860-870-0890
Practice Address - Street 1:357 HARTFORD TPKE
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4838
Practice Address - Country:US
Practice Address - Phone:860-871-2102
Practice Address - Fax:860-870-0890
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT78563208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics