Provider Demographics
NPI:1437175791
Name:LADD-SNIVELY, SUSAN E (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:LADD-SNIVELY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:E
Other - Last Name:LADD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1013 CHESTNUT LN
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-8566
Mailing Address - Country:US
Mailing Address - Phone:704-307-7686
Mailing Address - Fax:
Practice Address - Street 1:1013 CHESTNUT LN
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28104-8566
Practice Address - Country:US
Practice Address - Phone:704-307-7686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002-01273207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89132UTMedicaid
NC1437175791Medicaid
SCNC2552Medicaid
NC132UTOtherNCBCBS
SCNC2552Medicaid
NC89132UTMedicaid
NC2018160Medicare PIN
2018160AMedicare PIN