Individual ProviderSusan RedlineInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address221 Longwood Ave, Boston, MA 02115(617) 732-5500PECOS EnrollmentBased on the most recent information from CMS, provider Susan Redline does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1265618417Provider TypeIndividualFull NameRedline, SusanCredentialMDGenderFemaleSole ProprietorNoEnumeration Date1/18/2008Last Updated4/8/2019Contact InformationPractice LocationPractice Address221 Longwood Ave, Boston, MA 02115Phone(617) 732-5500FaxUnlisted FaxMailing LocationMailing Address221 Longwood Ave, Boston, MA 02115-5804PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense53406MassachusettsCode207RP1001XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense35047019OhioProvider IdentifiersIDDescriptionIssuerID4218092DescriptionOtherIssuerAETNAOhioID000000552365DescriptionOtherIssuerANTHEMOhioID0801823DescriptionMedicaidIssuerUnlistedOhioID363940DescriptionOtherIssuerWELLCAREOhioID000000233298DescriptionOtherIssuerUNISONOhio