Provider Demographics
NPI:1033315189
Name:RASHIDIAN, SUZANNE MARIE VASS (DO)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:MARIE VASS
Last Name:RASHIDIAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3276
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47731-3276
Mailing Address - Country:US
Mailing Address - Phone:812-473-0181
Mailing Address - Fax:812-473-5822
Practice Address - Street 1:3821 VINCENT STATION DR
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-9315
Practice Address - Country:US
Practice Address - Phone:270-478-5334
Practice Address - Fax:270-216-6920
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017364208600000X
KY03488207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201072560Medicaid
KY7100208180Medicaid
KY7100208180Medicaid