Provider Demographics
NPI:1003958844
Name:ZLOTNICK-HALE, SUSAN JUDITH (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JUDITH
Last Name:ZLOTNICK-HALE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:718 SMYTH RD
Mailing Address - Street 2:MANCHESTER VA MEDICAL CENTER - PRIMARY CARE
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104
Mailing Address - Country:US
Mailing Address - Phone:800-892-8384
Mailing Address - Fax:603-314-1653
Practice Address - Street 1:718 SMYTH RD
Practice Address - Street 2:MANCHESTER VA MEDICAL CENTER - PRIMARY CARE
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104
Practice Address - Country:US
Practice Address - Phone:800-892-8384
Practice Address - Fax:603-314-1653
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL15426207Q00000X
TXH-4814207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALE78571Medicare UPIN