Provider Demographics
NPI:1740202209
Name:SMIGA, SUSAN M (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:SMIGA
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 1:266 HANOVER CENTER RD
Mailing Address - Street 2:
Mailing Address - City:ETNA
Mailing Address - State:NH
Mailing Address - Zip Code:03750-4208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3810 ROSIN CT
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1656
Practice Address - Country:US
Practice Address - Phone:916-567-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG756962084P0800X
VT04200116322084P0804X
NH141012084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30207921Medicaid
VT1015248Medicaid
VT1015248Medicaid