Provider Demographics
NPI:1770571101
Name:ANDERSON, SUZANNE KOCHWESER (MD)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:KOCHWESER
Last Name:ANDERSON
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 1:4435 SENECA RD
Mailing Address - Street 2:
Mailing Address - City:TRUMANSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14886-9201
Mailing Address - Country:US
Mailing Address - Phone:607-387-5707
Mailing Address - Fax:607-387-4354
Practice Address - Street 1:172 KING RD E
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-9403
Practice Address - Country:US
Practice Address - Phone:607-272-0212
Practice Address - Fax:607-277-3785
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155383207QH0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00917208Medicaid
E15544Medicare UPIN
NY00917208Medicaid