1023014685 NPI number — DR. SUSAN L HERR AU.D.

Table of content: DR. SUSAN L HERR AU.D. (NPI 1023014685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023014685 NPI number — DR. SUSAN L HERR AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERR
Provider First Name:
SUSAN
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AU.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023014685
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1032 BOARDMAN-CANFIELD RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
BOARDMAN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-726-3339
Provider Business Mailing Address Fax Number:
330-726-0482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3622 BELMONT AVE.
Provider Second Line Business Practice Location Address:
SUITE 19
Provider Business Practice Location Address City Name:
YOUNGSTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-759-3593
Provider Business Practice Location Address Fax Number:
330-759-4032
Provider Enumeration Date:
06/28/2005

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: 231H00000X , with the licence number:  AT-000910-L , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: A01053 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 231H00000X , with the licence number: AT000910L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2915199 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000573568 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0746376 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0018232000001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2097985 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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