Provider Demographics
NPI:1396927794
Name:GRETH, SUZANNE M (MD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:M
Last Name:GRETH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7023 OLD JAHNKE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4126
Mailing Address - Country:US
Mailing Address - Phone:804-320-1353
Mailing Address - Fax:804-320-6636
Practice Address - Street 1:7023 OLD JAHNKE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4126
Practice Address - Country:US
Practice Address - Phone:804-320-1353
Practice Address - Fax:804-320-6636
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242620208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
2039024OtherCIGNA
1396927794OtherSOUTHERN HEALTH
10026695OtherOPTIMA HEALTH
344305OtherANTHEM
VA1396927794Medicaid
2175804OtherUNITED HEALTHCARE
586574OtherAETNA