1851300594 NPI number — SUSAN C PARKER MD

Table of content: SUSAN C PARKER MD (NPI 1851300594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851300594 NPI number — SUSAN C PARKER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKER
Provider First Name:
SUSAN
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CONGILOSI
Provider Other First Name:
SUSAN
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851300594
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
575 E RIVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85704-5822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-874-4135
Provider Business Mailing Address Fax Number:
520-874-4135

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 N CAMPBELL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85724-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-874-4135
Provider Business Practice Location Address Fax Number:
520-874-4135
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208C00000X , with the licence number:  36508 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 226217700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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