Provider Demographics
NPI:1780798231
Name:HAMMAR, SUSAN KAY (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAY
Last Name:HAMMAR
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 1:2211 W MAGNOLIA BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1753
Mailing Address - Country:US
Mailing Address - Phone:818-391-2400
Mailing Address - Fax:818-391-2409
Practice Address - Street 1:2211 W MAGNOLIA BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1753
Practice Address - Country:US
Practice Address - Phone:818-391-2400
Practice Address - Fax:818-391-2409
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53696208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG53696FMedicare ID - Type Unspecified
CAA52575Medicare UPIN