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
State | License ID | Taxonomies |
---|---|---|
OH | 35092367 | 2084N0400X |
OH | 35.092387 | 2084A2900X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2084A2900X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurocritical Care |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 2855987 | Medicaid | |
OH | 2855987 | Medicaid | |
4247011 | Medicare PIN |