Provider Demographics
NPI:1568414290
Name:ABBOTT, SUSAN BRINKMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:BRINKMAN
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 636256
Mailing Address - Street 2:CENTRAL CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-5504
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:4600 MCAULEY PLACE
Practice Address - Street 2:SUITE 115
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4733
Practice Address - Country:US
Practice Address - Phone:513-981-4646
Practice Address - Fax:513-981-4647
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.091128208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2873136Medicaid
OHH027012Medicare PIN