Provider Demographics
NPI:1619276177
Name:SUSZKO, JASON W (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:W
Last Name:SUSZKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 PENSACOLA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2118
Mailing Address - Country:US
Mailing Address - Phone:808-432-2000
Mailing Address - Fax:
Practice Address - Street 1:1010 PENSACOLA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2118
Practice Address - Country:US
Practice Address - Phone:808-432-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15757207ND0900X
HIMD-19180207N00000X
ORMD176186207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology