Provider Demographics
NPI:1770509317
Name:SUSAN E. DOWNEY, MD INC.
Entity Type:Organization
Organization Name:SUSAN E. DOWNEY, MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DOWNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-748-4930
Mailing Address - Street 1:181 S BUENA VISTA ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4504
Mailing Address - Country:US
Mailing Address - Phone:818-748-4930
Mailing Address - Fax:818-748-4928
Practice Address - Street 1:181 S BUENA VISTA ST FL 3
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4504
Practice Address - Country:US
Practice Address - Phone:818-748-4930
Practice Address - Fax:818-748-4928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62700208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19745Medicare PIN