Provider Demographics
NPI:1679887905
Name:SUSSMAN, STEPHANIE (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SUSSMAN
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 1:54 HORIZON DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-5797
Mailing Address - Country:US
Mailing Address - Phone:412-926-2172
Mailing Address - Fax:
Practice Address - Street 1:1181 WEAVER DAIRY RD STE 210
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-1870
Practice Address - Country:US
Practice Address - Phone:984-215-4339
Practice Address - Fax:984-215-4342
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-00592208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics