Provider Demographics
NPI:1063475804
Name:BATLAN, SUSAN J (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:BATLAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:470 GRANBY RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-3218
Mailing Address - Country:US
Mailing Address - Phone:413-535-1700
Mailing Address - Fax:413-535-1715
Practice Address - Street 1:470 GRANBY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-3218
Practice Address - Country:US
Practice Address - Phone:413-535-1700
Practice Address - Fax:413-535-1715
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2017-03-28
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Provider Licenses
StateLicense IDTaxonomies
MA219578207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2025361Medicaid
MAG24693Medicare UPIN
MAA36191Medicare PIN