Provider Demographics
NPI:1205944006
Name:LANDGRAF, SUSAN MARGARET (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARGARET
Last Name:LANDGRAF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170 WEST ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1712
Mailing Address - Country:US
Mailing Address - Phone:585-396-6990
Mailing Address - Fax:585-396-6995
Practice Address - Street 1:15 CANANDAIGUA ST
Practice Address - Street 2:
Practice Address - City:SHORTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14548-9763
Practice Address - Country:US
Practice Address - Phone:585-396-6990
Practice Address - Fax:585-396-6995
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179278207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01388274Medicaid
NYP010179278OtherEXCELLUS
NY110346BFOtherPREFERRED CARE
NYP010179278OtherEXCELLUS
NYRA7990Medicare ID - Type Unspecified