Provider Demographics
NPI:1457374597
Name:ROSS- WEBB, SUSAN DONNA (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:DONNA
Last Name:ROSS- WEBB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:DONNA
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:200 N GREENSBORO ST STE D7
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1833
Mailing Address - Country:US
Mailing Address - Phone:919-448-4498
Mailing Address - Fax:919-929-3952
Practice Address - Street 1:200 N GREENSBORO ST STE D7
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1833
Practice Address - Country:US
Practice Address - Phone:919-448-4498
Practice Address - Fax:919-929-3952
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC014282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911074Medicaid