1821105289 NPI number — DR. SUSAN WENTLAND HOWARD MD

Table of content: DR. SUSAN WENTLAND HOWARD MD (NPI 1821105289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821105289 NPI number — DR. SUSAN WENTLAND HOWARD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOWARD
Provider First Name:
SUSAN
Provider Middle Name:
WENTLAND
Provider Name Prefix Text:
DR.
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:
WENTLAND
Provider Other First Name:
SUSAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
II
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821105289
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 NORTH CLYDE MORRIS BLVD., SUITE 200
Provider Second Line Business Mailing Address:
HALIFAX FAMILY HEALTH CENTER
Provider Business Mailing Address City Name:
DAYTONA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32114-2765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-947-4665
Provider Business Mailing Address Fax Number:
386-258-4891

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 NORTH CLYDE MORRIS BLVD., SUITE 200
Provider Second Line Business Practice Location Address:
HALIFAX FAMILY HEALTH CENTER
Provider Business Practice Location Address City Name:
DAYTONA BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32114-2765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-947-4665
Provider Business Practice Location Address Fax Number:
386-258-4891
Provider Enumeration Date:
08/23/2006

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: 207Q00000X , with the licence number:  ME70337 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 255504200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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