Provider Demographics
NPI:1134119498
Name:PEKARSKE, SUSAN L (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:L
Last Name:PEKARSKE
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:PO BOX 35808
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740-5808
Mailing Address - Country:US
Mailing Address - Phone:520-297-7826
Mailing Address - Fax:520-544-0060
Practice Address - Street 1:6200 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3529
Practice Address - Country:US
Practice Address - Phone:520-297-7826
Practice Address - Fax:520-544-0060
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26755207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ431362Medicaid
AZAZ0830650OtherBLUE CROSS BLUE SHIELD
G25786Medicare UPIN
AZ431362Medicaid