Provider Demographics
NPI:1346299088
Name:CECCONI, SUZANNE MARIE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:MARIE
Last Name:CECCONI
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Gender:F
Credentials:MD, MPH
Other - Prefix:
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Mailing Address - Street 1:301 FISHER ST
Mailing Address - Street 2:KEESLER MEDICAL CENTER
Mailing Address - City:KEESLER AFB
Mailing Address - State:MI
Mailing Address - Zip Code:39534
Mailing Address - Country:US
Mailing Address - Phone:228-376-0402
Mailing Address - Fax:228-376-0198
Practice Address - Street 1:81ST MEDICAL GROUP/SGOC
Practice Address - Street 2:301 FISHER ST. ROOM 1A-132
Practice Address - City:KEESLER AFB
Practice Address - State:MS
Practice Address - Zip Code:39534
Practice Address - Country:US
Practice Address - Phone:228-376-0402
Practice Address - Fax:228-376-0198
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2007-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG85948208000000X
AL00024934208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG85948OtherMEDICAL LICENSE
AL00024934OtherMEDICAL LICENSE
H09375Medicare UPIN