Provider Demographics
NPI:1811174824
Name:CARMACK, SUSANNE (MD)
Entity type:Individual
Prefix:DR
First Name:SUSANNE
Middle Name:
Last Name:CARMACK
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 1:406 BLACK HILLS LN SW STE A
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8144
Mailing Address - Country:US
Mailing Address - Phone:360-704-3400
Mailing Address - Fax:360-754-1783
Practice Address - Street 1:406 BLACK HILLS LN SW STE A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8144
Practice Address - Country:US
Practice Address - Phone:360-704-3400
Practice Address - Fax:360-754-1783
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9908207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology