Provider Demographics
NPI:1467632414
Name:SUSAN BIEGEL MD INC
Entity Type:Organization
Organization Name:SUSAN BIEGEL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:BIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-985-1908
Mailing Address - Street 1:1113 ALTA AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-2803
Mailing Address - Country:US
Mailing Address - Phone:909-985-1908
Mailing Address - Fax:909-385-5583
Practice Address - Street 1:1113 ALTA AVE STE 220
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-2803
Practice Address - Country:US
Practice Address - Phone:909-985-1908
Practice Address - Fax:909-385-5583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66575207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110045232OtherRAILROAD MEDICARE
CAG66575OtherLICENSE
CAGR0100350Medicaid
CAE95508Medicare UPIN