Provider Demographics
NPI:1073589388
Name:BUCKINGHAM, SUSAN ISKANDRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ISKANDRIAN
Last Name:BUCKINGHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:ISKANDRIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:619 19TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35249-6805
Mailing Address - Country:US
Mailing Address - Phone:205-999-6854
Mailing Address - Fax:
Practice Address - Street 1:1400 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233
Practice Address - Country:US
Practice Address - Phone:205-933-9110
Practice Address - Fax:205-930-1156
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24922207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51005676OtherBLUE SHIELD OF AL.
AL303749373Medicaid
AL303769373Medicaid
AL303799373Medicaid
AL51005675OtherBLUE SHIELD OF AL.
AL051513571OtherBLUE SHIELD OF AL.
AL303719373Medicaid
AL303739373Medicaid
AL303709373Medicaid
AL51005681OtherBLUE SHIELD OF AL.
AL51005676OtherBLUE SHIELD OF AL.