Provider Demographics
NPI:1609936244
Name:AMOS, SUSAN S (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:S
Last Name:AMOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 S 1ST ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-3726
Mailing Address - Country:US
Mailing Address - Phone:812-232-2936
Mailing Address - Fax:812-232-9536
Practice Address - Street 1:2929 S 1ST ST
Practice Address - Street 2:SUITE 3
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-3726
Practice Address - Country:US
Practice Address - Phone:812-232-2936
Practice Address - Fax:812-232-9536
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01031117A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100251480AMedicaid
IN080191478OtherRAILROAD MEDICARE
IN100251480AMedicaid
IN147180ZMedicare ID - Type UnspecifiedMEDICARE NUMBER