Provider Demographics
NPI:1508036880
Name:SUSSMAN, BARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:
Last Name:SUSSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 BONNIE DOONE TER
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-1716
Mailing Address - Country:US
Mailing Address - Phone:949-759-1956
Mailing Address - Fax:
Practice Address - Street 1:1315 BONNIE DOONE TER
Practice Address - Street 2:
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-1716
Practice Address - Country:US
Practice Address - Phone:973-632-1652
Practice Address - Fax:973-632-1652
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG-037064207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology