Provider Demographics
NPI:1568525970
Name:FROMMEYER, SUSAN BETH (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:BETH
Last Name:FROMMEYER
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 1:501 19TH ST.
Mailing Address - Street 2:SUITE 401
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1839
Mailing Address - Country:US
Mailing Address - Phone:865-541-1975
Mailing Address - Fax:865-541-1976
Practice Address - Street 1:2004 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-1299
Practice Address - Country:US
Practice Address - Phone:606-248-3015
Practice Address - Fax:606-248-3024
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38437207V00000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64077357Medicaid
KY64077357Medicaid
0798201Medicare ID - Type Unspecified