Provider Demographics
NPI:1144204538
Name:BARDE, SUSAN HOLLIDAY (MD)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:HOLLIDAY
Last Name:BARDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 GOVERNORS PLACE BLVD
Mailing Address - Street 2:STE 110
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-1332
Mailing Address - Country:US
Mailing Address - Phone:937-296-0015
Mailing Address - Fax:937-296-0074
Practice Address - Street 1:3075 GOVERNORS PLACE BLVD
Practice Address - Street 2:STE 110
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-1332
Practice Address - Country:US
Practice Address - Phone:937-296-0015
Practice Address - Fax:937-296-0074
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350523342080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BA0569474Medicare ID - Type Unspecified
A16130Medicare UPIN