Basic Information
| Provider Information | |||||||||
| NPI: | 1750525291 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BABU | ||||||||
| FirstName: | SUMA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.B.B.S., M.P.H | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | B | ||||||||
| OtherFirstName: | SUMA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.B.B.S., M.P.H | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 165 CAMBRIDGE ST STE 668 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021142783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177243914 | ||||||||
| FaxNumber: | 6177247290 | ||||||||
| Practice Location | |||||||||
| Address1: | 165 CAMBRIDGE ST STE 668 | ||||||||
| Address2: | MASSACHUSETTS GENERAL HOSPITAL | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021142783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177243914 | ||||||||
| FaxNumber: | 6177247290 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2009 | ||||||||
| LastUpdateDate: | 03/09/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 262533 | MA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0008X | 262533 | MA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neuromuscular Medicine |
No ID Information.