Provider Demographics
NPI:1750321469
Name:FEENEY, SUSAN W (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:W
Last Name:FEENEY
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:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-0146
Mailing Address - Country:US
Mailing Address - Phone:360-565-9237
Mailing Address - Fax:360-417-7111
Practice Address - Street 1:844 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3045
Practice Address - Country:US
Practice Address - Phone:360-683-9895
Practice Address - Fax:360-582-5614
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063688A2085R0001X
OH350879372085R0001X
WY153552085R0001X
KY406422085R0001X
WAMD612897702085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2656362Medicaid
KY64118524Medicaid
IN200827320Medicaid
KYP00411791OtherMEDICARE RAILROAD
INP00969062OtherMEDICARE RAILROAD
KYP00411791OtherMEDICARE RAILROAD
OH2656362Medicaid
KY0625237Medicare PIN
KY64118524Medicaid