Provider Demographics
NPI:1578657797
Name:MCELROY-MARCUS, SUSAN PARR (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:PARR
Last Name:MCELROY-MARCUS
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 1:4850 SMITH RD STE 100A
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2797
Mailing Address - Country:US
Mailing Address - Phone:513-841-0777
Mailing Address - Fax:513-841-0877
Practice Address - Street 1:4850 SMITH RD STE 100A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-2797
Practice Address - Country:US
Practice Address - Phone:513-841-0777
Practice Address - Fax:513-841-0877
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052948207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0656946Medicaid
OHA82689Medicare UPIN
OHH424010Medicare PIN