Provider Demographics
NPI:1861459620
Name:BOWLING, SUSANA M (MD)
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:M
Last Name:BOWLING
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 1:525 E MARKET ST STE 1N
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1619
Mailing Address - Country:US
Mailing Address - Phone:330-375-3588
Mailing Address - Fax:330-375-7615
Practice Address - Street 1:75 ARCH ST STE 201
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1431
Practice Address - Country:US
Practice Address - Phone:330-375-3588
Practice Address - Fax:330-375-7615
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350923672084N0400X
OH35.0923872084A2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2855987Medicaid
OH2855987Medicaid
4247011Medicare PIN