Provider Demographics
NPI:1407892359
Name:HENTZ, SUZANNE K (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:K
Last Name:HENTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4815 OLEANDER DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-5108
Mailing Address - Country:US
Mailing Address - Phone:910-452-1133
Mailing Address - Fax:
Practice Address - Street 1:4815 OLEANDER DR
Practice Address - Street 2:SUITE 202
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-5108
Practice Address - Country:US
Practice Address - Phone:910-452-1133
Practice Address - Fax:910-452-5829
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29589207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C84463Medicare UPIN