Provider Demographics
NPI:1417998253
Name:BASH, SUZANNE (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:BASH
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 1:1516 COTNER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3303
Mailing Address - Country:US
Mailing Address - Phone:310-445-2951
Mailing Address - Fax:310-479-1459
Practice Address - Street 1:1516 COTNER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3303
Practice Address - Country:US
Practice Address - Phone:310-445-2951
Practice Address - Fax:310-479-1459
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA721752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A721750OtherBLUE SHIELD
CAGR0106039Medicaid
CA00A721750Medicaid
CA00A721752Medicare PIN
CA00A721750OtherBLUE SHIELD
CAWA72175JMedicare PIN
CAWA72175MMedicare PIN
CA00A721756Medicare PIN
CAWA72175IMedicare PIN
CAWA72175RMedicare PIN
CAWA72175CMedicare PIN
CAWA72175KMedicare PIN
CAWA72175QMedicare PIN
CAWA72175SMedicare PIN
CA00A721753Medicare PIN
CAWA72175FMedicare PIN
CAWA72175TMedicare PIN
CAWA72175OMedicare PIN
CA00A721755Medicare PIN
CAH88852Medicare UPIN
CAGR0106039Medicaid
CA00A721750Medicaid
CA00A721757Medicare PIN
CA00A721758Medicare PIN
CATP051AMedicare PIN
CA00A721754Medicare PIN
CAWA72175EMedicare PIN
CAWA72175PMedicare PIN