Provider Demographics
NPI:1306816533
Name:PANSING, SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:PANSING
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 1:7500 N DREAMY DRAW DR
Mailing Address - Street 2:STE. #133
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4660
Mailing Address - Country:US
Mailing Address - Phone:602-277-2245
Mailing Address - Fax:602-265-9494
Practice Address - Street 1:7500 N DREAMY DRAW DR
Practice Address - Street 2:STE. #133
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4660
Practice Address - Country:US
Practice Address - Phone:602-277-2245
Practice Address - Fax:602-265-9494
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ245462084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ366361Medicaid
AZWCKHLMedicare ID - Type Unspecified
AZWCKHR58Medicare ID - Type Unspecified
AZ102801Medicare ID - Type Unspecified
AZ66655Medicare ID - Type Unspecified
AZ67524Medicare ID - Type Unspecified
AZ366361Medicaid