Provider Demographics
NPI:1841240504
Name:GORMAN, SUSAN P (MD, PC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:P
Last Name:GORMAN
Suffix:
Gender:F
Credentials:MD, PC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MARIE
Other - Last Name:PLOSZAJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PC
Mailing Address - Street 1:77 CADILLAC DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-5453
Mailing Address - Country:US
Mailing Address - Phone:916-920-2082
Mailing Address - Fax:916-920-1430
Practice Address - Street 1:77 CADILLAC DR
Practice Address - Street 2:SUITE 230
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-5453
Practice Address - Country:US
Practice Address - Phone:916-920-2082
Practice Address - Fax:916-920-1430
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22835207V00000X
CAG79764207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G57297Medicare UPIN
R130898Medicare ID - Type Unspecified