Healthcare Provider Details

I. General information

NPI: 1538233184
Provider Name (Legal Business Name): SUZANNE MARIE PICA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 SHOPPERS DR SUITE 2
WINCHESTER KY
40391
US

IV. Provider business mailing address

505 SHOPPERS DR SUITE 2
WINCHESTER KY
40391
US

V. Phone/Fax

Practice location:
  • Phone: 859-744-1358
  • Fax: 859-744-3144
Mailing address:
  • Phone: 859-744-1358
  • Fax: 859-744-3144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number28114
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number28114
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: