Provider Demographics
NPI:1376717967
Name:QUINTER, SUZANNE DIETZ (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:DIETZ
Last Name:QUINTER
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 1:1050 EAST GREENVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ST MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2622
Mailing Address - Country:US
Mailing Address - Phone:419-394-3331
Mailing Address - Fax:419-394-3330
Practice Address - Street 1:1050 EAST GREENVILLE RD
Practice Address - Street 2:
Practice Address - City:ST MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-4588
Practice Address - Country:US
Practice Address - Phone:419-394-3331
Practice Address - Fax:419-394-3330
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.12009207N00000X
OH35 120090207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0073592Medicaid
OHH130660Medicare PIN