Provider Demographics
NPI:1235123860
Name:KRING, SUSAN JANE (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JANE
Last Name:KRING
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 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6306
Mailing Address - Fax:
Practice Address - Street 1:255 ENTERPRISE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6300
Practice Address - Country:US
Practice Address - Phone:864-454-8120
Practice Address - Fax:864-454-8125
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400223207Q00000X
SC40030207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D3759OtherMEDCOST RW
560794933OtherHEALTHSOURCE
560794933OtherUHC
136CXOtherNORTH CAROLINA
89136CXOtherNORTH CAROLINA
NC89136CXMedicaid
D2570OtherMEDCOST BR
D3758OtherMEDCOST DH
SC400301Medicaid
560794933OtherHEALTH CARE SAVINGS
560794933OtherHEALTHSOURCE
NCE37637Medicare ID - Type Unspecified
D2570OtherMEDCOST BR
E37637Medicare ID - Type UnspecifiedUGS DH
E37637Medicare ID - Type UnspecifiedUGS RW