Provider Demographics
NPI:1275596132
Name:ALCASID, SUSAN ALVARAN (MD)
Entity Type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:ALVARAN
Last Name:ALCASID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2110 LEITER RD
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3598
Mailing Address - Country:US
Mailing Address - Phone:937-384-4838
Mailing Address - Fax:937-384-4845
Practice Address - Street 1:945 DEIS DRIVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014
Practice Address - Country:US
Practice Address - Phone:513-858-2666
Practice Address - Fax:513-858-2685
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077430A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2199759Medicaid
OHH26588Medicare UPIN
OHH123440Medicare PIN
OHAL4222381Medicare PIN