Provider Demographics
NPI:1144202490
Name:MASSICK, SUSAN C (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:MASSICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-1707
Mailing Address - Fax:614-947-1716
Practice Address - Street 1:5175 MORSE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-1370
Practice Address - Country:US
Practice Address - Phone:614-293-1707
Practice Address - Fax:614-293-1716
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35078051207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2794669Medicaid
OHMA4114152Medicare PIN