Provider Demographics
NPI:1720012875
Name:AMATURO, SUSAN CHINN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:CHINN
Last Name:AMATURO
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 1:1002 MENDOCINO AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4330
Mailing Address - Country:US
Mailing Address - Phone:707-577-8292
Mailing Address - Fax:707-284-1230
Practice Address - Street 1:1002 MENDOCINO AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4330
Practice Address - Country:US
Practice Address - Phone:707-577-8292
Practice Address - Fax:707-284-1230
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60552207N00000X, 207ND0101X, 207ND0900X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFK810AOtherMEDICARE PROVIDER NUMBER
CAFK810AOtherMEDICARE PROVIDER NUMBER
CAE92120Medicare UPIN