Healthcare Provider Details

I. General information

NPI: 1962889485
Provider Name (Legal Business Name): SUSANNAH CHATHAM ORZELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSANNAH CHATHAM GOULD

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E BOULDER ST
COLORADO SPRINGS CO
80909-5533
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 719-364-4120
  • Fax: 719-364-4121
Mailing address:
  • Phone: 970-624-4123
  • Fax: 970-624-2416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD477843
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: