Provider Demographics
NPI:1497761431
Name:FARNSWORTH, SUZAMIE JO (DO)
Entity Type:Individual
Prefix:
First Name:SUZAMIE
Middle Name:JO
Last Name:FARNSWORTH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COULTER ROAD
Mailing Address - Street 2:CLIFTON SPRINGS HOSP CLIN ATTN MEDICAL STAFF OFFICE
Mailing Address - City:CLIFTON SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14432
Mailing Address - Country:US
Mailing Address - Phone:315-462-0486
Mailing Address - Fax:315-462-2487
Practice Address - Street 1:2 COULTER ROAD
Practice Address - Street 2:
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432
Practice Address - Country:US
Practice Address - Phone:315-462-0486
Practice Address - Fax:315-462-2487
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220866208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2164978Medicaid
NY02164978Medicaid
NYP00257277OtherRAILROAD MEDICARE
NY107007BJOtherPREFERRED CHOICE
P010220866OtherBLUE CHOICE
P020220866OtherROCHESTER BLUE SHIELD
NYP010220866OtherBLUE CHOICE
NY107007BJOtherPREFERRED CHOICE
G92293Medicare UPIN