Provider Demographics
NPI:1053350330
Name:LEVY, SUSAN JOY (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JOY
Last Name:LEVY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:JOY
Other - Last Name:SHAPERO (MAIDEN NAME)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 GRAHAM DRIVE
Mailing Address - Street 2:INTEGRATED SERVICES OF APPALACHIAN OHIO
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701
Mailing Address - Country:US
Mailing Address - Phone:740-249-4118
Mailing Address - Fax:740-594-9967
Practice Address - Street 1:280 N. HIGH STREET
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601
Practice Address - Country:US
Practice Address - Phone:740-772-6191
Practice Address - Fax:740-772-6188
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350452212084P0800X
OH35.0452212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000299397OtherANTHEM
OH24165000OtherMAGELLAN
OH0819476Medicaid
OHLEO731184Medicare PIN
OH0819476Medicaid
OHLEO731185Medicare PIN
OHF47445Medicare UPIN
OH000000299397OtherANTHEM
OHLEO731183Medicare PIN