Provider Demographics
NPI:1518021575
Name:SUSSMAN, MARK N (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:N
Last Name:SUSSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:3418 LOMA VISTA RD
Mailing Address - Street 2:STE A
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003
Mailing Address - Country:US
Mailing Address - Phone:805-642-8565
Mailing Address - Fax:805-642-8564
Practice Address - Street 1:825 NORTH 10TH STREET
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060
Practice Address - Country:US
Practice Address - Phone:805-933-8600
Practice Address - Fax:805-933-8664
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG24121207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G241210Medicaid
CA00G241210Medicaid