Provider Demographics
NPI:1083685465
Name:EPPLEY, SUZANNE M (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:M
Last Name:EPPLEY
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 1:340A MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12839-1530
Mailing Address - Country:US
Mailing Address - Phone:518-747-4117
Mailing Address - Fax:518-747-9837
Practice Address - Street 1:340A MAIN ST
Practice Address - Street 2:
Practice Address - City:HUDSON FALLS
Practice Address - State:NY
Practice Address - Zip Code:12839-1530
Practice Address - Country:US
Practice Address - Phone:518-747-4117
Practice Address - Fax:518-747-9837
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143465-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00758250Medicaid
NY00758250Medicaid
NYRA1156Medicare ID - Type Unspecified