Provider Demographics
NPI:1770743593
Name:XU, SU (MD)
Entity type:Individual
Prefix:
First Name:SU
Middle Name:
Last Name:XU
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 1:15416 N FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-1244
Mailing Address - Country:US
Mailing Address - Phone:813-960-2400
Mailing Address - Fax:813-960-2410
Practice Address - Street 1:4915 EHRLICH RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624
Practice Address - Country:US
Practice Address - Phone:813-960-2400
Practice Address - Fax:813-960-2410
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90020207ZP0102X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL592235385OtherMULTIPLAN
FL0081220OtherCIGNA
FL7367680OtherAETNA
FL43262OtherFL BLUE
FL102177400Medicaid
FL592235685OtherUNITED HC