Provider Demographics
NPI:1548220031
Name:AYARAM, SUSY (MD)
Entity Type:Individual
Prefix:
First Name:SUSY
Middle Name:
Last Name:AYARAM
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 1:222 GLEN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094
Mailing Address - Country:US
Mailing Address - Phone:972-636-8996
Mailing Address - Fax:
Practice Address - Street 1:4500 S LANCASTER DR
Practice Address - Street 2:VA HOSPITAL
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216
Practice Address - Country:US
Practice Address - Phone:214-857-1975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37366207R00000X
TXN7902207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64053200Medicaid
KYH65856Medicare UPIN
KY0546211Medicare ID - Type Unspecified