Provider Demographics
NPI:1780641126
Name:MORRIS, SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:MORRIS
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 1:2901 AMANDA LAKES DR
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-4463
Mailing Address - Country:US
Mailing Address - Phone:419-230-4204
Mailing Address - Fax:
Practice Address - Street 1:1005 BELLEFONTAINE AVE STE 360
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2887
Practice Address - Country:US
Practice Address - Phone:419-998-8205
Practice Address - Fax:419-998-8220
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071139207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000201386OtherANTHEM
OH080164656OtherRAILROAD MEDICARE
OH735051OtherBUCKEYE
OH03885OtherPARAMOUNT
OH0345559Medicaid
OH080164656OtherRAILROAD MEDICARE
OH735051OtherBUCKEYE
OHMO0813423Medicare PIN