Provider Demographics
NPI:1063481372
Name:WILKENS, SUSANNA S (MD)
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:S
Last Name:WILKENS
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 1:1 ELLIOT WAY
Mailing Address - Street 2:HOSPITALIST PROGRAM - ELLIOT HOSPITAL
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3502
Mailing Address - Country:US
Mailing Address - Phone:603-663-2271
Mailing Address - Fax:603-663-2273
Practice Address - Street 1:1 ELLIOT WAY
Practice Address - Street 2:HOSPITALIST PROGRAM - ELLIOT HOSPITAL
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3502
Practice Address - Country:US
Practice Address - Phone:603-663-2271
Practice Address - Fax:603-663-2273
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7641207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3206430OtherAETNA PIN
NHP00014363OtherRR MEDICARE
NH30200028Medicaid
NH406461OtherTUFTS PIN
NHE52438OtherANTHEM REFERRING UPIN
NHE52438OtherHPHC
NH2064OtherCIGNA PIN
NH0105247Y0NH02OtherANTHEM ACES #
NH0407215OtherUNITED HC
NH3206430OtherAETNA PIN
NH30200028Medicaid