Provider Demographics
NPI:1609824861
Name:KAISER, SUZANNE B (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:B
Last Name:KAISER
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 155
Mailing Address - Street 2:202 EAST FERRELL STREET
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-0155
Mailing Address - Country:US
Mailing Address - Phone:434-447-3899
Mailing Address - Fax:434-447-7120
Practice Address - Street 1:202 E FERRELL ST
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-2104
Practice Address - Country:US
Practice Address - Phone:434-447-3899
Practice Address - Fax:434-447-7120
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046990207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI086255OtherANTHEM
VA6007597Medicaid
VA43999OtherSENTARA
VAE96509Medicare UPIN