Provider Demographics
NPI:1629033154
Name:MORTON-PRADHAN, SUSAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:L
Last Name:MORTON-PRADHAN
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 1:500 W THOMAS RD
Mailing Address - Street 2:SUITE 670
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4224
Mailing Address - Country:US
Mailing Address - Phone:602-234-1300
Mailing Address - Fax:602-234-0202
Practice Address - Street 1:500 W THOMAS RD
Practice Address - Street 2:SUITE 670
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4224
Practice Address - Country:US
Practice Address - Phone:602-234-1287
Practice Address - Fax:602-234-0202
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32650207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZI08384OtherUPIN
AZWCKJX03Medicare ID - Type UnspecifiedMEDICARE ID