Provider Demographics
NPI:1205820529
Name:CRAPES, SUSAN ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELLEN
Last Name:CRAPES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:E
Other - Last Name:CRAPES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2605
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-5405
Mailing Address - Country:US
Mailing Address - Phone:740-592-0585
Mailing Address - Fax:
Practice Address - Street 1:8 HARDING ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-1662
Practice Address - Country:US
Practice Address - Phone:740-592-0585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35039946C207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
311155352OtherE V BENEFITS
0100324OtherUNITED HEALTHCARE MC
311155352OtherEMERALD HEALTH
311155352OtherCIGNA/CONN GEN
OH000000118708OtherANTHEM
311155352OtherTRICARE
311155352OtherAETNA
0100340OtherUNITED HEALTHCARE -NL
OH0489136Medicaid
311155352OtherGREAT WEST
OH311155352OtherOHIO HEALTH CHOICE
311155352OtherCENTRAL BENEFITS
311155352OtherNATIONWIDE
311155352OtherPPO NEXT
OH311155352OtherOHIO HEALTH CHOICE
311155352OtherE V BENEFITS
OHCR2016381Medicare ID - Type UnspecifiedNEW LEXINGTON OHIO OFFICE