Provider Demographics
NPI:1093776320
Name:CURTIS, SUSAN EDWARDS (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:EDWARDS
Last Name:CURTIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:EDWARDS-LOIDL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10130 PERIMETER PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-0197
Mailing Address - Country:US
Mailing Address - Phone:980-745-6225
Mailing Address - Fax:
Practice Address - Street 1:10130 PERIMETER PKWY STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-0197
Practice Address - Country:US
Practice Address - Phone:980-945-7225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-004982084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1093776320Medicaid
MA2114577Medicaid
SCNC1875Medicaid
MA2114577Medicaid
NCNCD651AMedicare PIN
NC1093776320Medicaid