Provider Demographics
NPI:1629254685
Name:SUSON, SHARON MATARLO (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:MATARLO
Last Name:SUSON
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 1:3004 TOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2542
Mailing Address - Country:US
Mailing Address - Phone:919-490-9800
Mailing Address - Fax:
Practice Address - Street 1:3004 TOWER BLVD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2542
Practice Address - Country:US
Practice Address - Phone:919-490-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-21
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-01127207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2008-01127OtherLIC #
NC2008-01127OtherLIC #