Provider Demographics
NPI:1013065879
Name:HOLLANDER, SUSAN LINDSAY (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LINDSAY
Last Name:HOLLANDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:L P
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2601 JAHN AVE NW STE A4
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8905
Mailing Address - Country:US
Mailing Address - Phone:360-742-3538
Mailing Address - Fax:717-674-6171
Practice Address - Street 1:1708 RIDGECREST
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48306-3160
Practice Address - Country:US
Practice Address - Phone:815-715-2299
Practice Address - Fax:717-674-6171
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK295022084N0400X
MO20110103492084N0400X
IN01069283A2084N0400X
WAMD603155502084N0400X, 2084N0600X, 246ZE0600X
VA1012514552084N0400X
TN481672084N0400X
PAMD4454052084N0400X
NY2523832084N0400X
KY454552084N0400X
IL036.1176262084N0400X
IAMD-386422084N0400X
FLME1122702084N0400X
MI43010688432084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1013065879Medicaid
IL273586431-62401-01Medicaid
ILOF36369OtherBCBS-IL
MIH11820Medicare UPIN
ILOF36369OtherBCBS-IL
IL273586431-62401-01Medicaid
ILIL448602Medicare PIN