1164741492 NPI number — MS. SUSAN R DUKE N.P

Table of content: MS. SUSAN R DUKE N.P (NPI 1164741492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164741492 NPI number — MS. SUSAN R DUKE N.P

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUKE
Provider First Name:
SUSAN
Provider Middle Name:
R
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
N.P
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:
1164741492
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3721 WESTERRE PARKWAY SUITE 7F
Provider Second Line Business Mailing Address:
GAERTNER PSYCHIATRIC, P.C
Provider Business Mailing Address City Name:
HENRICO
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-269-4916
Provider Business Mailing Address Fax Number:
804-918-6114

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3721 WESTERRE PARKWAY
Provider Second Line Business Practice Location Address:
GAERTNER PSYCHIATRIC, PC
Provider Business Practice Location Address City Name:
HENRICO
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-269-4916
Provider Business Practice Location Address Fax Number:
804-918-6114
Provider Enumeration Date:
05/26/2010

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: 363LA2200X , with the licence number:  0024168550 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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