Provider Demographics
NPI:1316006505
Name:CHOI, SUSANNA (MD)
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:
Last Name:CHOI
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 1:10233 S PARKER RD
Mailing Address - Street 2:UNIT 200
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-9314
Mailing Address - Country:US
Mailing Address - Phone:303-805-1264
Mailing Address - Fax:303-805-1164
Practice Address - Street 1:10233 S PARKER RD
Practice Address - Street 2:UNIT 200
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9314
Practice Address - Country:US
Practice Address - Phone:303-805-1264
Practice Address - Fax:303-805-1164
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24190207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04013710Medicaid
CO04013710Medicaid
CR6318Medicare ID - Type Unspecified
COCR6308Medicare PIN