Healthcare Provider Details

I. General information

NPI: 1548434004
Provider Name (Legal Business Name): SUSAN MARIE IRELAND M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 10TH ST SE
CEDAR RAPIDS IA
52403-2450
US

IV. Provider business mailing address

202 10TH ST SE
CEDAR RAPIDS IA
52403-2414
US

V. Phone/Fax

Practice location:
  • Phone: 319-247-3820
  • Fax: 888-494-1997
Mailing address:
  • Phone: 319-247-3820
  • Fax: 888-494-1997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number39489
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: