Provider Demographics
NPI:1497975874
Name:LONGMUIR, SUSANNAH QUISLING (MD)
Entity type:Individual
Prefix:DR
First Name:SUSANNAH
Middle Name:QUISLING
Last Name:LONGMUIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSANNAH
Other - Middle Name:VIRGINIA
Other - Last Name:QUISLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:593 STEWARTS FERRY PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3414
Mailing Address - Country:US
Mailing Address - Phone:615-885-4900
Mailing Address - Fax:615-885-4719
Practice Address - Street 1:593 STEWARTS FERRY PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3414
Practice Address - Country:US
Practice Address - Phone:615-885-4900
Practice Address - Fax:615-885-4719
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA37041207W00000X
TNMD0000046118207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA55963OtherWELLMARK BCBS
IA55963OtherWELLMARK BCBS