Provider Demographics
NPI:1376602292
Name:COLASURDO, SUSAN GROVER (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:GROVER
Last Name:COLASURDO
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 1:1600 EXECUTIVE PARKWAY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-653-9619
Mailing Address - Fax:541-653-8129
Practice Address - Street 1:1600 EXECUTIVE PARKWAY
Practice Address - Street 2:SUITE 250
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-653-9619
Practice Address - Fax:541-653-8129
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD144192084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry