1205820529 NPI number — SUSAN ELLEN CRAPES M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205820529 NPI number — SUSAN ELLEN CRAPES M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

CRAPES

Provider First Name:

SUSAN

Provider Middle Name:

ELLEN

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

CRAPES

Provider Other First Name:

SUSAN

Provider Other Middle Name:

E.

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

M.D.

Provider Other Last Name Type Code:

2

NPI Number:

1205820529

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/03/2018

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 2605

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

ATHENS

Provider Business Mailing Address State Name:

OH

Provider Business Mailing Address Postal Code:

45701-5405

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

740-592-0585

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

8 HARDING ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

ATHENS

Provider Business Practice Location Address State Name:

OH

Provider Business Practice Location Address Postal Code:

45701-1662

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

740-592-0585

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

08/31/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207QG0300X , with the licence number:  35039946C , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 311155352 . This is a "E V BENEFITS" identifier . This identifiers is of the category "OTHER".
• Identifier: 0100324 . This is a "UNITED HEALTHCARE MC" identifier . This identifiers is of the category "OTHER".
• Identifier: 311155352 . This is a "EMERALD HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 311155352 . This is a "CIGNA/CONN GEN" identifier . This identifiers is of the category "OTHER".
• Identifier: 000000118708 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 311155352 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 311155352 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 0100340 . This is a "UNITED HEALTHCARE -NL" identifier . This identifiers is of the category "OTHER".
• Identifier: 0489136 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: 311155352 . This is a "GREAT WEST" identifier . This identifiers is of the category "OTHER".
• Identifier: 311155352 . This is a "OHIO HEALTH CHOICE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 311155352 . This is a "CENTRAL BENEFITS" identifier . This identifiers is of the category "OTHER".
• Identifier: 311155352 . This is a "NATIONWIDE" identifier . This identifiers is of the category "OTHER".
• Identifier: 311155352 . This is a "PPO NEXT" identifier . This identifiers is of the category "OTHER".