MEDICARE: STEPHEN CHESTER SUFFIN M.D.

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
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	G025413	CA

General Provider Information

NPI Number	:	1609993088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN CHESTER SUFFIN M.D.

Provider Business Mailing Address
First Line	:	13151 CHANDLER BLVD
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91401-6040
Country	:	US
Telephone Number	:	818-997-7660
Fax Number	:	818-997-7660

Provider Business Practice Location Address
First Line	:	8401 FALLBROOK AVE
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91304-3226
Country	:	US
Telephone Number	:	818-737-6266
Fax Number	:	818-737-6076

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	07/08/2007

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