Provider Demographics
NPI:1619985033
Name:DURHAM, SUSAN RENEE (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:RENEE
Last Name:DURHAM
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 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:DHMC
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-653-9880
Mailing Address - Fax:603-650-0908
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:DHMC
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-653-9880
Practice Address - Fax:603-650-0908
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12487207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010928Medicaid
NH30204686Medicaid
VT1010928Medicaid
H73610Medicare UPIN
NHUX4792Medicare PIN