Provider Demographics
NPI:1821233537
Name:EARL, SUSANNE ELISE (MD)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:ELISE
Last Name:EARL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSANNE
Other - Middle Name:ELISE
Other - Last Name:GALYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 W CALIFORNIA BLVD
Mailing Address - Street 2:HUNTINGTON HOSPITAL-GME OFFICE
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105
Mailing Address - Country:US
Mailing Address - Phone:626-397-5188
Mailing Address - Fax:
Practice Address - Street 1:100 W CALIFORNIA BLVD
Practice Address - Street 2:HUNTINGTON HOSPITAL- GME OFFICE
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105
Practice Address - Country:US
Practice Address - Phone:626-397-5188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA128568390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program