Provider Demographics
NPI:1134125115
Name:CANNING, SUZANNE BALLEW (MD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:BALLEW
Last Name:CANNING
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 1:7810 BROWN ST
Mailing Address - Street 2:STE 203
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4358
Mailing Address - Country:US
Mailing Address - Phone:425-556-9306
Mailing Address - Fax:425-556-0999
Practice Address - Street 1:7810 BROWN ST
Practice Address - Street 2:STE 203
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4358
Practice Address - Country:US
Practice Address - Phone:425-556-9306
Practice Address - Fax:425-556-0999
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
WAMD000362532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAB86188Medicare UPIN