Provider Demographics
NPI:1710993803
Name:SEEDMAN, SUSAN ANN (MD, FACS, PC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ANN
Last Name:SEEDMAN
Suffix:
Gender:F
Credentials:MD, FACS, PC
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 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:805-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:1010 LAS LOMAS RD NE
Practice Address - Street 2:SUITE #1
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2634
Practice Address - Country:US
Practice Address - Phone:505-248-1518
Practice Address - Fax:505-248-1610
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM83-108174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM010758OtherBC/BS OF NM
NM25508OtherPRESBYTERIAN
NM26229Medicaid
NM25508OtherPRESBYTERIAN
NM800521128Medicare ID - Type UnspecifiedMEDICARE