Provider Demographics
NPI:1851303259
Name:DAB, SUSAN BERKOWITZ (MD)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:BERKOWITZ
Last Name:DAB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:RUTH
Other - Last Name:BERKOWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:525 SPRUCE STREET
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-2682
Mailing Address - Country:US
Mailing Address - Phone:415-668-8900
Mailing Address - Fax:415-668-1695
Practice Address - Street 1:525 SPRUCE STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-2682
Practice Address - Country:US
Practice Address - Phone:415-668-8900
Practice Address - Fax:415-668-1695
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45583208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA943327292OtherTAX ID NUMBER