1487952206 NPI number — MS. SUSAN LEA PAGE PSYD

Table of content: MS. SUSAN LEA PAGE PSYD (NPI 1487952206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487952206 NPI number — MS. SUSAN LEA PAGE PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAGE
Provider First Name:
SUSAN
Provider Middle Name:
LEA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NADEAU
Provider Other First Name:
SUSAN
Provider Other Middle Name:
LEA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487952206
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
411 OAK STREET
Provider Second Line Business Mailing Address:
STERLING MEDICAL ASSOCIATES ATTN: CREDENTIALS
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-984-1800
Provider Business Mailing Address Fax Number:
513-984-4909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 OAK ST
Provider Second Line Business Practice Location Address:
STERLING MEDICAL ASSOCIATES
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45219-2504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-984-1800
Provider Business Practice Location Address Fax Number:
513-984-4909
Provider Enumeration Date:
03/02/2011

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: 103TC0700X , with the licence number:  4008 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: 071.007102 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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