Provider Demographics
NPI:1578532271
Name:TOUMA, SUSAN CLAIRE (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CLAIRE
Last Name:TOUMA
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 1:422 KINETIC PARK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3803
Mailing Address - Country:US
Mailing Address - Phone:304-523-5100
Mailing Address - Fax:304-523-1750
Practice Address - Street 1:422 KINETIC PARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3803
Practice Address - Country:US
Practice Address - Phone:304-523-5100
Practice Address - Fax:304-523-1750
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20440174400000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1808741000Medicaid
WVTO4090671Medicare ID - Type Unspecified
WV1808741000Medicaid