Provider Demographics
NPI:1063451813
Name:RASCHAL, SUSAN P (DO)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:P
Last Name:RASCHAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9800 SHELBYVILLE RD
Mailing Address - Street 2:STE 220
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2992
Mailing Address - Country:US
Mailing Address - Phone:502-429-8585
Mailing Address - Fax:855-656-7325
Practice Address - Street 1:1350 MACKEY BRANCH DR
Practice Address - Street 2:SUITE 114
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3482
Practice Address - Country:US
Practice Address - Phone:423-468-3267
Practice Address - Fax:423-468-3270
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2021-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNDO01251207K00000X
GA044989207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G63634Medicare UPIN