Provider Demographics
NPI:1225026826
Name:NEIL, SUSAN ERICA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ERICA
Last Name:NEIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2101 NICHOLASVILLE RD
Mailing Address - Street 2:206
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2518
Mailing Address - Country:US
Mailing Address - Phone:859-278-6345
Mailing Address - Fax:859-278-1677
Practice Address - Street 1:2101 NICHOLASVILLE RD
Practice Address - Street 2:206
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2518
Practice Address - Country:US
Practice Address - Phone:859-278-6345
Practice Address - Fax:859-278-1677
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY26109207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080144961OtherRR MEDICARE
KY18D0962807OtherCLIA
KY64261092Medicaid
KY64261092Medicaid
KY18D0962807OtherCLIA