Provider Demographics
NPI:1013229061
Name:EMMERLING, SUSAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:EMMERLING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3130 KETTERING BLVD BLDG B
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1924
Mailing Address - Country:US
Mailing Address - Phone:937-991-3188
Mailing Address - Fax:937-223-9811
Practice Address - Street 1:9000 N MAIN ST
Practice Address - Street 2:SUITE 232
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415
Practice Address - Country:US
Practice Address - Phone:937-277-8988
Practice Address - Fax:937-274-4293
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2022-03-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35123733207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0105039Medicaid