Provider Demographics
NPI:1588637565
Name:FOSNOT, SUSAN J (DO)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:FOSNOT
Suffix:
Gender:F
Credentials:DO
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 748817
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8817
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:401 CORBETT ST
Practice Address - Street 2:SUITE 400
Practice Address - City:BELLEAIR
Practice Address - State:FL
Practice Address - Zip Code:33756-7309
Practice Address - Country:US
Practice Address - Phone:727-462-2229
Practice Address - Fax:727-447-5610
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL058516207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251910101Medicaid
FL1215135090OtherGROUP NPI
FL251910100Medicaid
I39725Medicare UPIN
FL251910100Medicaid
FL40924Medicare PIN