Provider Demographics
NPI:1881711257
Name:OBATA, SUSAN T (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:T
Last Name:OBATA
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Gender:F
Credentials:MD
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Mailing Address - Street 1:555 COLE ST
Mailing Address - Street 2:COMMUNITY HEALTH PROGRAMS FOR YOUTH-COLE ST CLINIC
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-2800
Mailing Address - Country:US
Mailing Address - Phone:415-751-8181
Mailing Address - Fax:415-386-8212
Practice Address - Street 1:555 COLE ST
Practice Address - Street 2:COMMUNITY HEALTH PROGRAMS FOR YOUTH-COLE ST CLINIC
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-2800
Practice Address - Country:US
Practice Address - Phone:415-751-8181
Practice Address - Fax:415-386-8212
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG67882207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
021147OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER
F46780Medicare UPIN