Provider Demographics
NPI:1699812842
Name:MEAD, MARIA SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:SUSAN
Last Name:MEAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:125 WATER ST STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-2792
Mailing Address - Country:US
Mailing Address - Phone:831-427-3582
Mailing Address - Fax:831-427-7785
Practice Address - Street 1:250 LOCUST ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3813
Practice Address - Country:US
Practice Address - Phone:831-427-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA068971207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH55226Medicare UPIN