Provider Demographics
NPI:1952324071
Name:BAYER, SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:BAYER
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 1:630 W MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TILTON
Mailing Address - State:NH
Mailing Address - Zip Code:03276-5044
Mailing Address - Country:US
Mailing Address - Phone:603-286-3371
Mailing Address - Fax:
Practice Address - Street 1:630 W MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:TILTON
Practice Address - State:NH
Practice Address - Zip Code:03276-5044
Practice Address - Country:US
Practice Address - Phone:603-286-3371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7250207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30001211Medicaid
NHE42339Medicare UPIN
NHRE1041Medicare ID - Type Unspecified