Provider Demographics
NPI:1700819729
Name:MONOHAN, SUSAN M (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:MONOHAN
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 1:1775 ALYSHEBA WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-9023
Mailing Address - Country:US
Mailing Address - Phone:859-278-5007
Mailing Address - Fax:859-278-6867
Practice Address - Street 1:1775 ALYSHEBA WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-9023
Practice Address - Country:US
Practice Address - Phone:859-278-5007
Practice Address - Fax:859-278-6867
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38363207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64086952Medicaid
I14300Medicare UPIN
KYP400035298Medicare PIN