Provider Demographics
NPI:1477510147
Name:SCARLA, SUSAN D (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:SCARLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:D
Other - Last Name:MCCARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2251 N 32ND ST LOT 22
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-2445
Mailing Address - Country:US
Mailing Address - Phone:480-924-9615
Mailing Address - Fax:480-833-0210
Practice Address - Street 1:5656 S POWER RD
Practice Address - Street 2:
Practice Address - City:HIGLEY
Practice Address - State:AZ
Practice Address - Zip Code:85236-5421
Practice Address - Country:US
Practice Address - Phone:480-840-3733
Practice Address - Fax:480-969-6132
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13951207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ246969Medicaid
AZ105661Medicare ID - Type Unspecified
AZ246969Medicaid