Provider Demographics
NPI:1275561037
Name:PYLE, SUSAN K (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:PYLE
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 1:835 SWEITZER ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-1007
Mailing Address - Country:US
Mailing Address - Phone:937-548-1141
Mailing Address - Fax:
Practice Address - Street 1:622 E ELM ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:OH
Practice Address - Zip Code:45390-1722
Practice Address - Country:US
Practice Address - Phone:937-968-7946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046127207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100211130Medicaid
OH0123646Medicaid
OH000000494612OtherANTHEM
OHPY7364821Medicare PIN
IN100211130Medicaid
OHA82862Medicare UPIN