Provider Demographics
NPI:1053316224
Name:RICE, SUSAN G (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:RICE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:S
Other - Last Name:GROWNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 140068
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-0068
Mailing Address - Country:US
Mailing Address - Phone:419-531-2232
Mailing Address - Fax:419-381-2752
Practice Address - Street 1:419 N REYNOLDS
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615
Practice Address - Country:US
Practice Address - Phone:419-531-2232
Practice Address - Fax:419-531-2359
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067035C208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4713041Medicaid
OH4713041Medicaid
OHH56456Medicare UPIN