Provider Demographics
NPI:1073512224
Name:SCHMITT, SUSAN ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ANN
Last Name:SCHMITT
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:PO BOX 165
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:WV
Mailing Address - Zip Code:26287-0165
Mailing Address - Country:US
Mailing Address - Phone:304-478-1181
Mailing Address - Fax:
Practice Address - Street 1:229 WALNUT ST
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:WV
Practice Address - Zip Code:26287-1046
Practice Address - Country:US
Practice Address - Phone:304-478-2600
Practice Address - Fax:304-478-2604
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2011-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11004207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0050739000Medicaid
WV0050739000Medicaid