Provider Demographics
NPI:1275718645
Name:SUSAN MARIE ARCENEAUX MD INC
Entity Type:Organization
Organization Name:SUSAN MARIE ARCENEAUX MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ARCENEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-721-4776
Mailing Address - Street 1:805 E WASHINGTON ST
Mailing Address - Street 2:STE. 100
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3340
Mailing Address - Country:US
Mailing Address - Phone:330-721-4776
Mailing Address - Fax:330-725-0054
Practice Address - Street 1:805 E WASHINGTON ST
Practice Address - Street 2:STE. 100
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3340
Practice Address - Country:US
Practice Address - Phone:330-721-4776
Practice Address - Fax:330-725-0054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063143174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0903080Medicaid
OHF 51808Medicare UPIN
OH0903080Medicaid