Provider Demographics
NPI:1508840216
Name:HOEKSTRA, SUZANNE A (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:A
Last Name:HOEKSTRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 FORE RIVER PKWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2780
Mailing Address - Country:US
Mailing Address - Phone:207-553-6800
Mailing Address - Fax:207-553-6810
Practice Address - Street 1:195 FORE RIVER PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2780
Practice Address - Country:US
Practice Address - Phone:207-553-6800
Practice Address - Fax:207-553-6810
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800276174400000X
ME018518208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891146UMedicaid
NC1146UOtherBCBS
NC891146UMedicaid
NC2254368AMedicare PIN
NC1146UOtherBCBS
NC2254368Medicare PIN