Provider Demographics
NPI:1639190457
Name:KLEIN, SUSAN K (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:KERINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:330-543-8050
Mailing Address - Fax:330-543-8054
Practice Address - Street 1:1 PERKINS SQ
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1063
Practice Address - Country:US
Practice Address - Phone:330-543-8050
Practice Address - Fax:330-543-8054
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0584202084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH743191OtherBCMH
OHE29894Medicare UPIN
OH647552OtherAETNA
OH0743191Medicaid
OH000000526036OtherANTHEM
OH363711OtherWELLCARE
OH000000221124OtherUNISON
PA1010371600001OtherPA MEDICAID
OHKL4072971Medicare PIN
OHKL4072975Medicare PIN
OH745929OtherBUCKEYE
OH000000027123OtherANTHEM