Provider Demographics
NPI:1245201201
Name:BALLAGH, SUSAN AUCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:AUCOTT
Last Name:BALLAGH
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 1:1000 W CARSON ST # 3
Mailing Address - Street 2:DEPARTMENT OF OBSTETRICS & GYNECOLOGY
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2004
Mailing Address - Country:US
Mailing Address - Phone:310-222-3544
Mailing Address - Fax:310-782-8148
Practice Address - Street 1:1000 W CARSON ST # 3
Practice Address - Street 2:DEPARTMENT OF OBSTETRICS & GYNECOLOGY
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2004
Practice Address - Country:US
Practice Address - Phone:310-222-3544
Practice Address - Fax:310-782-8148
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056727207V00000X, 207VE0102X
CAG62297207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA56588OtherSENTARA
VA332690OtherANTHEM
NC790612MMedicaid
351316OtherUHC/MAMSI
NC0612MOtherNC BC/BS
VA006210724Medicaid
VAF40551Medicare UPIN
351316OtherUHC/MAMSI
NC790612MMedicaid
VA006210724Medicaid