Provider Demographics
NPI:1134104375
Name:DAVIS, SUSAN SCHRIMPF (DO)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:SCHRIMPF
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:URSULA
Other - Last Name:SCHRIMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 636256
Mailing Address - Street 2:CENTRAL CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-5502
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:305 CRESCENT AVE
Practice Address - Street 2:UNIVERSITY WYOMING FAMILY PRACTICE CENTER
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-4406
Practice Address - Country:US
Practice Address - Phone:513-821-0275
Practice Address - Fax:513-821-3621
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-006680207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2158801Medicaid
OH4311511Medicare PIN
G92742Medicare UPIN
DA0873072Medicare ID - Type Unspecified
OHDA0873079Medicare PIN
OHDA7363111Medicare PIN
OH2158801Medicaid