Provider Demographics
NPI:1982894721
Name:OAKLEY, SUSAN HOLDEN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:HOLDEN
Last Name:OAKLEY
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-757-2132
Mailing Address - Fax:859-301-7010
Practice Address - Street 1:610 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3416
Practice Address - Country:US
Practice Address - Phone:859-757-2132
Practice Address - Fax:859-301-7010
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.096837207V00000X
IN01085714A207VF0040X
KY46875207VF0040X, 207V00000X
SCLL30007207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0106598Medicaid
KY7100306630Medicaid
KY7100306630Medicaid