Provider Demographics
NPI:1063464816
Name:AUSTIN, SUSAN MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARY
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 FORD AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-5811
Mailing Address - Country:US
Mailing Address - Phone:518-462-3047
Mailing Address - Fax:518-274-0397
Practice Address - Street 1:186 FORD AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-5811
Practice Address - Country:US
Practice Address - Phone:518-462-3047
Practice Address - Fax:518-274-0397
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1953372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01697763Medicaid
NY01697763Medicaid