Provider Demographics
NPI:1285862011
Name:AREECKAL, SUSAN V (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:V
Last Name:AREECKAL
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 1:340 DAVIES AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14586-8807
Mailing Address - Country:US
Mailing Address - Phone:585-748-7153
Mailing Address - Fax:
Practice Address - Street 1:30 HAGEN DR
Practice Address - Street 2:SUITE 320
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2658
Practice Address - Country:US
Practice Address - Phone:585-922-0181
Practice Address - Fax:585-922-0185
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266965207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine