Provider Demographics
NPI:1578583076
Name:SUCCOP, SUZANNE YVETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:YVETTE
Last Name:SUCCOP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 EQUESTRIAN DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3361
Mailing Address - Country:US
Mailing Address - Phone:561-738-7007
Mailing Address - Fax:561-738-7421
Practice Address - Street 1:200 KNUTH RD
Practice Address - Street 2:SUITE 150
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-4629
Practice Address - Country:US
Practice Address - Phone:561-738-7007
Practice Address - Fax:561-738-7421
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62069207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378265400Medicaid
FL378265400Medicaid
FL27448AMedicare PIN