Provider Demographics
NPI:1558680504
Name:DEMAREST, SUSAN PENG (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:PENG
Last Name:DEMAREST
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:2125 RIVER RD STE 303
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-1136
Practice Address - Country:US
Practice Address - Phone:518-213-6910
Practice Address - Fax:518-213-6915
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2021-11-15
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Provider Licenses
StateLicense IDTaxonomies
NY277624207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04102383Medicaid