Provider Demographics
NPI:1245287051
Name:BERDY, SUSAN S (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:S
Last Name:BERDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:456 N NEW BALLAS RD
Mailing Address - Street 2:SUITE 129
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6831
Mailing Address - Country:US
Mailing Address - Phone:314-569-1881
Mailing Address - Fax:314-569-3277
Practice Address - Street 1:456 N NEW BALLAS RD
Practice Address - Street 2:SUITE 129
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6831
Practice Address - Country:US
Practice Address - Phone:314-569-1881
Practice Address - Fax:314-569-3277
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR8F57207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE55266Medicare UPIN
MO1013454Medicare ID - Type Unspecified
MO6010765Medicare ID - Type Unspecified