Provider Demographics
NPI:1407924475
Name:AHART, SUSAN LEE (MD, MA)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LEE
Last Name:AHART
Suffix:
Gender:F
Credentials:MD, MA
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:920 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472
Mailing Address - Country:US
Mailing Address - Phone:707-331-0388
Mailing Address - Fax:707-823-0762
Practice Address - Street 1:1049 4TH ST
Practice Address - Street 2:STE H
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4345
Practice Address - Country:US
Practice Address - Phone:707-522-8641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG805382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry