Provider Demographics
NPI:1609860592
Name:BRATSCHI, SUSAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:S
Last Name:BRATSCHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:E
Other - Last Name:STAGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:633 GOVERNOR CARLOS CAMACHO RD.
Mailing Address - Street 2:STE. 210
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913
Mailing Address - Country:US
Mailing Address - Phone:671-649-1001
Mailing Address - Fax:674-649-1002
Practice Address - Street 1:633 GOVERNOR CARLOS CAMACHO RD.
Practice Address - Street 2:STE. 210
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-649-1001
Practice Address - Fax:671-649-1002
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM1753207RC0000X, 207UN0901X, 207R00000X, 207RI0011X
FLME79643207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272536300Medicaid
FL01623OtherBCBS
FL01623OtherBCBS
I39170Medicare UPIN
FL272536300Medicaid