Provider Demographics
NPI:1275544710
Name:RANSOME, SUSAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:S
Last Name:RANSOME
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 1:22601 PACIFIC COAST HWY STE 240
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-5823
Mailing Address - Country:US
Mailing Address - Phone:310-456-6505
Mailing Address - Fax:
Practice Address - Street 1:22601 PACIFIC COAST HWY STE 240
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-5823
Practice Address - Country:US
Practice Address - Phone:310-456-6505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77170207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G771700OtherMEDICAL PPIN #
CAG34556Medicare UPIN
CAWG77170BMedicare ID - Type UnspecifiedPPIN #