Provider Demographics
NPI:1073526364
Name:SUSFAL, EWA ANNA (MD)
Entity Type:Individual
Prefix:
First Name:EWA
Middle Name:ANNA
Last Name:SUSFAL
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 1:55 HOLLY SPRINGS PARK DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28734-0719
Mailing Address - Country:US
Mailing Address - Phone:828-349-3550
Mailing Address - Fax:828-349-5087
Practice Address - Street 1:55 HOLLY SPRINGS PARK DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-0719
Practice Address - Country:US
Practice Address - Phone:828-349-3550
Practice Address - Fax:828-349-5087
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400983207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89137VFMedicaid
NC137VFOtherBCBS
NC89137VFMedicaid
NC2032993BMedicare PIN
NC2032993AMedicare PIN