Provider Demographics
NPI:1164476263
Name:STEPHENS, SUSAN ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELLEN
Last Name:STEPHENS
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 1:8007 AUBURN RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CONCORD TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-9621
Mailing Address - Country:US
Mailing Address - Phone:440-296-5915
Mailing Address - Fax:440-709-8403
Practice Address - Street 1:8007 AUBURN RD STE 2
Practice Address - Street 2:
Practice Address - City:CONCORD TWP
Practice Address - State:OH
Practice Address - Zip Code:44077-9621
Practice Address - Country:US
Practice Address - Phone:440-296-5915
Practice Address - Fax:440-709-8403
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35056000207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0880480Medicaid
OH0880480Medicaid
OH5766740001Medicare NSC