Provider Demographics
NPI:1972507465
Name:PLYMALE, SUSAN ELAINE (RD)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ELAINE
Last Name:PLYMALE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2924 HOLT ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-4080
Mailing Address - Country:US
Mailing Address - Phone:606-329-9444
Mailing Address - Fax:606-324-5423
Practice Address - Street 1:2916 HOLT ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-4080
Practice Address - Country:US
Practice Address - Phone:606-324-7181
Practice Address - Fax:606-324-5423
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0341173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0788802Medicare PIN
KYQ10836Medicare UPIN