Provider Demographics
NPI:1952379083
Name:FERRELL, SUSAN M (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:FERRELL
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 1:272 NEWSTOCK ROAD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804
Mailing Address - Country:US
Mailing Address - Phone:360-477-2396
Mailing Address - Fax:
Practice Address - Street 1:272 NEWSTOCK ROAD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804
Practice Address - Country:US
Practice Address - Phone:360-477-2396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045660207ZP0101X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1110FEOtherREGENCE BLUE SHIELD RIDER
WA8439044Medicaid
1110FEOtherREGENCE BLUE SHIELD RIDER
H20908Medicare UPIN