Provider Demographics
NPI:1356348239
Name:SAMUEL, SUZANA MARCELLA (MD)
Entity type:Individual
Prefix:MRS
First Name:SUZANA
Middle Name:MARCELLA
Last Name:SAMUEL
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 1:4045 E BELL RD
Mailing Address - Street 2:STE 121
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2236
Mailing Address - Country:US
Mailing Address - Phone:602-867-2884
Mailing Address - Fax:602-482-2872
Practice Address - Street 1:4045 E BELL RD
Practice Address - Street 2:STE 121
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2236
Practice Address - Country:US
Practice Address - Phone:602-867-2884
Practice Address - Fax:602-482-2872
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13916207V00000X
IN30897207V00000X
NY15102207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ260084Medicaid
D37571Medicare UPIN