Provider Demographics
NPI:1679529523
Name:ADLER, SUSAN (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ADLER
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 7793
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94120-7793
Mailing Address - Country:US
Mailing Address - Phone:925-951-1366
Mailing Address - Fax:925-951-1385
Practice Address - Street 1:1783 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3205
Practice Address - Country:US
Practice Address - Phone:650-696-5400
Practice Address - Fax:650-696-5208
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60253207L00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G602530Medicaid
00G602530Medicare ID - Type Unspecified
CA00G602530Medicaid