Provider Demographics
NPI:1174592331
Name:ROE, SUSAN J (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:J
Last Name:ROE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1175 NININGER RD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-1056
Mailing Address - Country:US
Mailing Address - Phone:651-480-4100
Mailing Address - Fax:651-480-6801
Practice Address - Street 1:1175 NININGER RD
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-1056
Practice Address - Country:US
Practice Address - Phone:651-480-4100
Practice Address - Fax:651-480-6801
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30221207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN138T5ROOtherBLUE CROSS
MN984811034012OtherPREFERRED ONE
MN11-00304OtherMEDICA
MNHP42296OtherHEALTHPARTNERS
MN138T5ROOtherBLUE CROSS
MNH54139Medicare UPIN