Provider Demographics
NPI:1295880417
Name:LEBLANC, SUSANN (MD)
Entity type:Individual
Prefix:DR
First Name:SUSANN
Middle Name:
Last Name:LEBLANC
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 1:280 MAIN ST STE 410
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-2921
Mailing Address - Country:US
Mailing Address - Phone:603-595-7388
Mailing Address - Fax:603-595-8624
Practice Address - Street 1:280 MAIN ST STE 410
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-2921
Practice Address - Country:US
Practice Address - Phone:603-595-7388
Practice Address - Fax:603-595-8624
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14465208000000X
FL91204208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics