Provider Demographics
NPI:1467876425
Name:SUZANNE M QUARDT, MD, INC
Entity Type:Organization
Organization Name:SUZANNE M QUARDT, MD, INC
Other - Org Name:DR Q PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:QUARDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-324-2660
Mailing Address - Street 1:70017 HIGHWAY 111
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-2999
Mailing Address - Country:US
Mailing Address - Phone:760-324-2660
Mailing Address - Fax:760-324-2677
Practice Address - Street 1:70017 HIGHWAY 111
Practice Address - Street 2:SUITE 1
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-2999
Practice Address - Country:US
Practice Address - Phone:760-324-2660
Practice Address - Fax:760-324-2677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65369208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI 63788Medicare UPIN