Provider Demographics
NPI:1801138631
Name:SUSAN E SEIDEMAN MD PC
Entity type:Organization
Organization Name:SUSAN E SEIDEMAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:LOBNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANAIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-683-2970
Mailing Address - Street 1:23601 AVALON BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-5582
Mailing Address - Country:US
Mailing Address - Phone:310-595-4367
Mailing Address - Fax:310-549-5022
Practice Address - Street 1:23601 AVALON BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-5582
Practice Address - Country:US
Practice Address - Phone:310-595-4367
Practice Address - Fax:310-549-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty