Provider Demographics
NPI:1801875968
Name:CHITTUM, SUSAN LYNNE (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LYNNE
Last Name:CHITTUM
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:PSC 482 BOX 244
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96362
Mailing Address - Country:US
Mailing Address - Phone:8-161-1743
Mailing Address - Fax:743-7632
Practice Address - Street 1:PSC 482 BOX 244
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96362
Practice Address - Country:US
Practice Address - Phone:8-161-1743
Practice Address - Fax:743-7632
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA39943207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology