Provider Demographics
NPI:1609858323
Name:SMOLEN, SUSAN G (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:SMOLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2441 WEST STATE ROAD 426
Mailing Address - Street 2:SUITE 2011
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-4515
Mailing Address - Country:US
Mailing Address - Phone:407-678-6888
Mailing Address - Fax:407-678-0252
Practice Address - Street 1:2441 WEST STATE ROAD 426
Practice Address - Street 2:SUITE 2011
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-4515
Practice Address - Country:US
Practice Address - Phone:407-678-6888
Practice Address - Fax:407-678-0252
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME90314207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43162ZMedicare ID - Type Unspecified
FLI07444Medicare UPIN