Provider Demographics
NPI:1811022213
Name:ATWATER, SUSAN K (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:ATWATER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:300 PASTEUR DR RM L235
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:650-723-5255
Mailing Address - Fax:650-725-7409
Practice Address - Street 1:300 PASTEUR DR RM L235
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-723-5255
Practice Address - Fax:650-725-7409
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA49680207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A496800Medicaid
CAF01997Medicare UPIN
CA00A496801Medicare ID - Type Unspecified