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NPI Code Detail

MEDICARE: SUSAN ALEXANDRA ROATEN MD

MEDICARE: SUSAN ALEXANDRA ROATEN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207L00000XAnesthesiology Physician0000060177TN

General Provider Information

NPI Number : 1376030916
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN ALEXANDRA ROATEN MD
Provider Business Mailing Address
First Line : PO BOX 171181
Second Line :
City : MEMPHIS
State : TN
Zip : 38187-1181
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5545 MURRAY AVE STE 130
Second Line :
City : MEMPHIS
State : TN
Zip : 38119-3861
Country : US
Telephone Number : 901-682-6828
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2018
Last Update Date : 07/22/2022

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Directions to “ SUSAN ALEXANDRA ROATEN MD” Practice Location

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