Provider Demographics
NPI:1699860049
Name:WOODS, SUSAN SWARTZ (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:SWARTZ
Last Name:WOODS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:HANNA
Other - Last Name:SWARTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12 POND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3130
Mailing Address - Country:US
Mailing Address - Phone:207-747-7408
Mailing Address - Fax:
Practice Address - Street 1:MAINE BEHAVIORAL HEALTH
Practice Address - Street 2:235 MAIN STREET
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005
Practice Address - Country:US
Practice Address - Phone:207-294-8692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014677207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1086Medicare ID - Type Unspecified
ORME1086Medicare UPIN
E42209Medicare UPIN