Provider Demographics
NPI:1639424526
Name:TRACHTENBERG, SUSANNE NATALIE (MD)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:NATALIE
Last Name:TRACHTENBERG
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 1:828 MAIN STREET
Mailing Address - Street 2:SUITE 1702
Mailing Address - City:LYNCHBUR
Mailing Address - State:PA
Mailing Address - Zip Code:24504
Mailing Address - Country:US
Mailing Address - Phone:434-528-3263
Mailing Address - Fax:
Practice Address - Street 1:828 MAIN ST
Practice Address - Street 2:SUITE 1702
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24504-1500
Practice Address - Country:US
Practice Address - Phone:434-528-3263
Practice Address - Fax:617-807-0958
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 4289662084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology