Provider Demographics
NPI:1639268840
Name:AYCOCK, SUSAN E (MD)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:E
Last Name:AYCOCK
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 1:304 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-3602
Mailing Address - Country:US
Mailing Address - Phone:910-640-6615
Mailing Address - Fax:910-640-1088
Practice Address - Street 1:304 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3602
Practice Address - Country:US
Practice Address - Phone:910-640-6615
Practice Address - Fax:910-640-1088
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32982207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8912407Medicaid
NC12407OtherBCBS NC
NC8912407Medicaid
NCE39630Medicare UPIN