Provider Demographics
NPI:1437122983
Name:SU, CLAUDE (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAUDE
Middle Name:
Last Name:SU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 MERCY BLVD
Mailing Address - Street 2:PLAZA D
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1753
Mailing Address - Country:US
Mailing Address - Phone:912-961-8647
Mailing Address - Fax:912-927-5016
Practice Address - Street 1:11700 MERCY BLVD
Practice Address - Street 2:PLAZA D
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1753
Practice Address - Country:US
Practice Address - Phone:912-961-8647
Practice Address - Fax:912-927-5016
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035147207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA004888771EMedicaid
GA060052295OtherMEDICARE RAILROAD
GA004888771EMedicaid
GAC74178Medicare UPIN