Provider Demographics
NPI:1245347020
Name:COFFEY, SUSAN CRICHTON (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:CRICHTON
Last Name:COFFEY
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:UCSF-SFGH, POSITIVE HEALTH PROGRAM, BOX 0874
Mailing Address - Street 2:995 POTRERO AVE.
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110
Mailing Address - Country:US
Mailing Address - Phone:415-476-4082
Mailing Address - Fax:415-502-4777
Practice Address - Street 1:995 POTRERO AVENUE
Practice Address - Street 2:BLDG 80 WARD 84
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-476-4082
Practice Address - Fax:415-476-6953
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA64426207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A644260Medicaid
CA11023037OtherRAILROAD MEDICARE
CA11023037OtherRAILROAD MEDICARE
CA00A644260Medicaid