Provider Demographics
NPI:1700811932
Name:NEDOROST, SUSAN T (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:T
Last Name:NEDOROST
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 1:2359 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEXLEY
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2359 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BEXLEY
Practice Address - State:OH
Practice Address - Zip Code:43209-2421
Practice Address - Country:US
Practice Address - Phone:614-947-1716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-058786207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0818511Medicaid
746100OtherBUCKEYE
000000221277OtherUNISON
OH2141158OtherAETNA
363874OtherWELLCARE
OH000000523166OtherANTHEM
OH000000140403OtherANTHEM
OH70013089OtherRAILROAD MEDICARE
OHP00406584OtherRAILROAD MEDICARE
OHP00406584OtherRAILROAD MEDICARE
363874OtherWELLCARE
OH2141158OtherAETNA