Provider Demographics
NPI:1346449386
Name:SUSKI, RONALD T (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:T
Last Name:SUSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11 OXFORD DR
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1622
Mailing Address - Country:US
Mailing Address - Phone:860-344-3901
Mailing Address - Fax:860-344-4413
Practice Address - Street 1:11 OXFORD DR
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1622
Practice Address - Country:US
Practice Address - Phone:860-344-3901
Practice Address - Fax:860-344-4413
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT21488208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice