Provider Demographics
NPI:1437369501
Name:IGDALOFF, SUSAN GAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:GAIL
Last Name:IGDALOFF
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 1:24019 BRIARDALE WAY
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-3946
Mailing Address - Country:US
Mailing Address - Phone:661-255-5803
Mailing Address - Fax:
Practice Address - Street 1:24019 BRIARDALE WAY
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-3946
Practice Address - Country:US
Practice Address - Phone:661-255-5803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG034970208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG349700Medicaid