Provider Demographics
NPI:1881629558
Name:COVENTRY, SUSAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:C
Last Name:COVENTRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1941 BISHOP LN STE 1018
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1928
Mailing Address - Country:US
Mailing Address - Phone:502-456-6211
Mailing Address - Fax:502-456-4440
Practice Address - Street 1:231 E CHESTNUT ST
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1821
Practice Address - Country:US
Practice Address - Phone:502-629-7900
Practice Address - Fax:502-629-7906
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34658207ZP0213X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000049668OtherANTHEM BLUE CROSS BS
P00211997OtherRAILROAD MEDICARE
KY1087837OtherPASSPORT MEDICAID
1337243OtherUNITED MINE WORKERS
IN200206670AMedicaid
KY64346588Medicaid
P00211997OtherRAILROAD MEDICARE
IN200206670AMedicaid