Provider Demographics
NPI:1003812454
Name:NAPOLEON, MARY SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:MARY SUSAN
Middle Name:
Last Name:NAPOLEON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 DRIVING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1057
Mailing Address - Country:US
Mailing Address - Phone:315-331-8921
Mailing Address - Fax:315-331-8231
Practice Address - Street 1:1210 DRIVING PARK AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1057
Practice Address - Country:US
Practice Address - Phone:315-331-8921
Practice Address - Fax:315-331-8231
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145955207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00711211Medicaid
NM040426005030OtherFIDELS CARE
NY770140OtherMVP
NY6742OtherBLUE CROSS/BLUE SHIELD
NY102386CROtherPREFERRED CARE
NY0070649OtherGHI
NY00711211Medicaid
NYB75022Medicare UPIN