Tatiana Suvorov

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA6778 Issued in MA

Practice address

Cha Revere Family Care Center
454 Broadway
Revere, MA 02151

Phone

(781) 485-8222

NPI assigned

Sep 5, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Tatiana Saunders Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560384000000",
    "number": "1346599420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "CAMBRIDGE HEALTH ALLIANCE",
            "address_2": "1493 CAMBRIDGE STREET",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "02139",
            "telephone_number": "617-665-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CHA REVERE FAMILY CARE CENTER",
            "address_2": "454 BROADWAY",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "02151",
            "telephone_number": "781-485-8222"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 East 233rd St",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "10466",
            "country_code": "US",
            "telephone_number": "718-920-9177",
            "fax_number": "718-920-9106",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUVOROV",
        "first_name": "TATIANA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-05",
        "last_updated": "2019-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MA",
            "license": "PA6778",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "015788",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TATIANA",
            "last_name": "SAUNDERS",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Sandra Margaret Sweetnam, MD
• Kimberly Anne Tanger, LICENSED CPHT
• Shalimar Tarek, LMHC
• Beatrice K Tchouta
• Albert Tecci, MS

• Medical Physician Assistant in Revere, MA
• Providers in Revere, MA by specialty
• Medical Physician Assistant in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.