Provider Demographics
NPI:1770513533
Name:KAROL, SUSAN VERONICA (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:VERONICA
Last Name:KAROL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 CUMMINGS CTR
Mailing Address - Street 2:SUITE 106P
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6115
Mailing Address - Country:US
Mailing Address - Phone:978-922-9226
Mailing Address - Fax:978-922-9203
Practice Address - Street 1:100 CUMMINGS CTR
Practice Address - Street 2:SUITE 106P
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6115
Practice Address - Country:US
Practice Address - Phone:978-922-9226
Practice Address - Fax:978-922-9203
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA58861208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3074285Medicaid
MA3074285Medicaid
MAJ10295Medicare ID - Type Unspecified