Provider Demographics
NPI:1629178637
Name:ZUSMAN, EDIE E (MD)
Entity Type:Individual
Prefix:
First Name:EDIE
Middle Name:E
Last Name:ZUSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1860 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3590
Mailing Address - Country:US
Mailing Address - Phone:707-646-4370
Mailing Address - Fax:707-646-4904
Practice Address - Street 1:1860 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3590
Practice Address - Country:US
Practice Address - Phone:707-646-4370
Practice Address - Fax:707-646-4904
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG64158207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G641580Medicaid
00G641582Medicare ID - Type Unspecified
CA00G641580Medicaid