Provider Demographics
NPI:1578517983
Name:DANTONI, SUSAN ELISE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELISE
Last Name:DANTONI
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 1:18 STONEY CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-4601
Mailing Address - Country:US
Mailing Address - Phone:585-586-7488
Mailing Address - Fax:
Practice Address - Street 1:90 OFFICE PARK WAY
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1749
Practice Address - Country:US
Practice Address - Phone:585-586-3640
Practice Address - Fax:585-586-3796
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207593207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1995275Medicaid
NY1995275Medicaid
NYDD0480Medicare ID - Type Unspecified