Provider Demographics
NPI:1700082468
Name:DUNBAR, SUSAN P (CNM)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:P
Last Name:DUNBAR
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 BROAD RD
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-5100
Mailing Address - Country:US
Mailing Address - Phone:315-492-5915
Mailing Address - Fax:
Practice Address - Street 1:4850 BROAD RD
Practice Address - Street 2:CGH POB SUITE 2C
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-5100
Practice Address - Country:US
Practice Address - Phone:315-492-5915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001203367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00673518Medicaid
NY02691427Medicaid
P00428222Medicare PIN
NY02691427Medicaid