Provider Demographics
NPI:1801848403
Name:SLADE, SUSAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:R
Last Name:SLADE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2134 NICHOLASVILLE RD
Mailing Address - Street 2:SUITE # 16&17
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2521
Mailing Address - Country:US
Mailing Address - Phone:859-309-9368
Mailing Address - Fax:859-309-9369
Practice Address - Street 1:2134 NICHOLASVILLE RD
Practice Address - Street 2:SUITE # 16&17
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2521
Practice Address - Country:US
Practice Address - Phone:859-309-9368
Practice Address - Fax:859-309-9369
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY340852084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0500922Medicare PIN
KY0500104Medicare PIN
KY0500231Medicare PIN
KYH64865Medicare UPIN