Provider Demographics
NPI:1093798241
Name:REED, SUSAN ELAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELAINE
Last Name:REED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:ELAINE
Other - Last Name:DUNKIN-BLANTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:424 WARDS CORNER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-6966
Mailing Address - Country:US
Mailing Address - Phone:513-576-7700
Mailing Address - Fax:513-576-1020
Practice Address - Street 1:631 E STATE ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:OH
Practice Address - Zip Code:45121-1437
Practice Address - Country:US
Practice Address - Phone:937-378-6387
Practice Address - Fax:937-378-4253
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35050128D207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0558570OtherMOLINA
OH300016OtherAMERIGROUP
OH000000255900OtherANTHEM
OH0558570Medicaid
OH113651073027OtherCARESOURCE
OHA15858Medicare UPIN
OH0558570Medicaid