Provider Demographics
NPI:1932294980
Name:SUSSMAN, ERNEST M (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:M
Last Name:SUSSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8550 W DESERT INN RD
Mailing Address - Street 2:STE. 102-254
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-4401
Mailing Address - Country:US
Mailing Address - Phone:702-293-0176
Mailing Address - Fax:702-293-0938
Practice Address - Street 1:3196 S MARYLAND PKWY
Practice Address - Street 2:STE. 410
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2305
Practice Address - Country:US
Practice Address - Phone:702-293-0176
Practice Address - Fax:702-293-0938
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG68463208800000X
NV6328208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019147Medicaid
NV6328OtherNEVADA MEDICAL LICENSE
NVCS06238OtherNV STATE PHARMACY
NVAS2877516OtherDEA
NVCS06238OtherNV STATE PHARMACY
NVAS2877516OtherNEVADA STATE PHARMACY #