Provider Demographics
NPI:1578649067
Name:HALL, SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:HALL
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:PO BOX 2357
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93581-2357
Mailing Address - Country:US
Mailing Address - Phone:661-822-4421
Mailing Address - Fax:661-822-6250
Practice Address - Street 1:432A WEST J STREET
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561
Practice Address - Country:US
Practice Address - Phone:661-822-4421
Practice Address - Fax:661-822-6250
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76766207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI20601Medicare UPIN
CAI20601Medicare UPIN