Healthcare Provider Details

I. General information

NPI: 1083668248
Provider Name (Legal Business Name): SUSHMA PANT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 05/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 IDAHO STREET
LEWISTON ID
83501
US

IV. Provider business mailing address

PO BOX 816
LEWISTON ID
83501-0816
US

V. Phone/Fax

Practice location:
  • Phone: 208-743-7427
  • Fax: 208-743-7421
Mailing address:
  • Phone: 208-743-2511
  • Fax: 208-799-5528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberM-6586
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD00032228
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: