Provider Demographics
NPI:1154300911
Name:SANTRY, SUSAN M (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:SANTRY
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:PO BOX 8503
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-8503
Mailing Address - Country:US
Mailing Address - Phone:203-249-6767
Mailing Address - Fax:203-531-1901
Practice Address - Street 1:127E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-3208
Practice Address - Country:US
Practice Address - Phone:203-249-6767
Practice Address - Fax:203-531-1901
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1705661207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01069832Medicaid
NY01069832Medicaid
NY03E251Medicare ID - Type Unspecified