Provider Demographics
NPI:1114903408
Name:OHORO, SUSAN KIERNAN (MD, MPH, FSIR)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KIERNAN
Last Name:OHORO
Suffix:
Gender:F
Credentials:MD, MPH, FSIR
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:SUSAN
Other - Last Name:KIERNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 116700
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-6700
Mailing Address - Country:US
Mailing Address - Phone:904-399-5550
Mailing Address - Fax:904-346-4334
Practice Address - Street 1:8375 DIX ELLIS TRL STE 201
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-8241
Practice Address - Country:US
Practice Address - Phone:904-399-5550
Practice Address - Fax:904-346-4334
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2210362085R0202X, 2085R0204X
CT735112085R0204X
GA935752085R0204X
IL0361623922085R0204X
WV320012085R0204X
IN01088585S2085R0204X
KY575452085R0204X
NV229852085R0204X
NMMD2022-13872085R0204X
NY3193182085R0204X
OH35.1466922085R0204X
SC890802085R0204X
TXU01682085R0204X
FLME1600682085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA469827OtherTUFTS HEALTH CARE
MA2084074Medicaid
MAT28128OtherBLUE CROSS BLUE SHIELD
I18596Medicare UPIN
MAT28128OtherBLUE CROSS BLUE SHIELD