Provider Demographics
NPI:1275535106
Name:RAY, SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:RAY
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 1:411 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1542
Mailing Address - Country:US
Mailing Address - Phone:330-252-0600
Mailing Address - Fax:330-252-0700
Practice Address - Street 1:411 E MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1542
Practice Address - Country:US
Practice Address - Phone:330-252-0600
Practice Address - Fax:330-252-0700
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053139R207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH130016751OtherRR MEDICARE
OH0746901Medicaid
OHD97975Medicare UPIN
OH0632283Medicare PIN