Provider Demographics
NPI:1003865056
Name:MERCER, SUSAN E (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:MERCER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2600 SIXTH STREET SW
Mailing Address - Street 2:AULTMAN HOSPITAL
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710
Mailing Address - Country:US
Mailing Address - Phone:330-452-9911
Mailing Address - Fax:330-588-4717
Practice Address - Street 1:2600 SIXTH STREET SW
Practice Address - Street 2:AULTMAN HOSPITAL
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710
Practice Address - Country:US
Practice Address - Phone:330-452-9911
Practice Address - Fax:330-588-4717
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35D48727207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0513706Medicaid
A15352Medicare UPIN
OH0513706Medicaid