Provider Demographics
NPI:1508837238
Name:MATHE, SUSANNA A (MD)
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:A
Last Name:MATHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7301 FOREST AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3792
Mailing Address - Country:US
Mailing Address - Phone:804-288-2767
Mailing Address - Fax:804-288-9897
Practice Address - Street 1:165 WADSWORTH DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23236-4500
Practice Address - Country:US
Practice Address - Phone:804-272-9146
Practice Address - Fax:804-330-5929
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2013-04-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA01010385742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6100112Medicaid
D82165Medicare UPIN
VA6100112Medicaid