Provider Demographics
NPI:1679631881
Name:SUSKIN, DAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:
Last Name:SUSKIN
Suffix:
Gender:M
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:PO BOX 2606
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30048-2606
Mailing Address - Country:US
Mailing Address - Phone:770-921-4492
Mailing Address - Fax:770-696-3358
Practice Address - Street 1:700 MEDICAL CENTER BLVD
Practice Address - Street 2:GWINNETT WOMENS PAVILION
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7693
Practice Address - Country:US
Practice Address - Phone:770-921-4492
Practice Address - Fax:770-696-3358
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0368832080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10052477Medicaid
GA52412187OtherBLUE CROSS
GA117057Medicaid
GA322063Medicaid
GA000700983DMedicaid
GA000700983FMedicaid
GA000700983BMedicaid