Provider Demographics
NPI:1639199839
Name:BRISKIN, SUSANNAH M (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSANNAH
Middle Name:M
Last Name:BRISKIN
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 1:24701 EUCLID AVENUE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-7700
Practice Address - Fax:216-286-6341
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-080901208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000221349OtherUNISON
OH000000525910OtherANTHEM
PA1018526430001Medicaid
OH000000368501OtherANTHEM
OH2335440OtherBCMH
OH729107OtherBUCKEYE
OH2335440Medicaid
OH363381OtherWELLCARE
OH7022369OtherAETNA
OH2335440Medicaid
OH000000221349OtherUNISON
OH363381OtherWELLCARE
OHBR4084593Medicare PIN