Provider Demographics
NPI:1609855832
Name:CLARK-FRANTZ, SUSAN E (MD)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:E
Last Name:CLARK-FRANTZ
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 1:1309 NORTON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-6530
Mailing Address - Country:US
Mailing Address - Phone:330-825-2355
Mailing Address - Fax:330-706-0213
Practice Address - Street 1:1309 NORTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTON
Practice Address - State:OH
Practice Address - Zip Code:44203-6530
Practice Address - Country:US
Practice Address - Phone:330-825-2355
Practice Address - Fax:330-706-0213
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074823C207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35074823COtherSTATE LICENSE
OH2088922Medicaid
OHBF2636112OtherDEA
OH35074823COtherSTATE LICENSE
OH2088922Medicaid