Healthcare Provider Details

I. General information

NPI: 1275921850
Provider Name (Legal Business Name): SUSAN ELIZABETH FOLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 GRAND ISLE WAY
PALM BEACH GARDENS FL
33418-4581
US

IV. Provider business mailing address

1004 GRAND ISLE WAY
PALM BEACH GARDENS FL
33418-4581
US

V. Phone/Fax

Practice location:
  • Phone: 561-775-7578
  • Fax: 561-775-7578
Mailing address:
  • Phone: 561-775-7578
  • Fax: 561-775-7578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 49748
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: