Provider Demographics
NPI:1588677553
Name:LELKO, SUSAN E (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:LELKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4 FARM SPRINGS RD
Mailing Address - Street 2:PROHEALTH PHYSICIANS
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2573
Mailing Address - Country:US
Mailing Address - Phone:860-284-5200
Mailing Address - Fax:860-284-5333
Practice Address - Street 1:816 BROAD ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-4350
Practice Address - Country:US
Practice Address - Phone:203-238-1256
Practice Address - Fax:203-237-2162
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT043132208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH60476Medicare UPIN