Provider Demographics
NPI:1578529012
Name:CEDERSTROM, SUSAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:J
Last Name:CEDERSTROM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:400 NEWPORT CENTER DR
Mailing Address - Street 2:SUITE 608
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7601
Mailing Address - Country:US
Mailing Address - Phone:949-644-3565
Mailing Address - Fax:949-718-6736
Practice Address - Street 1:400 NEWPORT CENTER DR
Practice Address - Street 2:SUITE 608
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7601
Practice Address - Country:US
Practice Address - Phone:949-644-3565
Practice Address - Fax:949-718-6736
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG33323207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG33323BMedicare ID - Type Unspecified
CAA45505Medicare UPIN