Provider Demographics
NPI:1982610226
Name:WISHNIA, SUSANA C (MD)
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:C
Last Name:WISHNIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2014 WASHINGTON ST STE 665
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1699
Mailing Address - Country:US
Mailing Address - Phone:617-243-3724
Mailing Address - Fax:617-243-9993
Practice Address - Street 1:NEWTON WELLESLEY HOSPITAL
Practice Address - Street 2:2014 WASHINGTON STREET, GREEN SUITE 665
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462
Practice Address - Country:US
Practice Address - Phone:617-243-3724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA230050208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery