Healthcare Provider Details

I. General information

NPI: 1871795948
Provider Name (Legal Business Name): SUSAN MAE LAIDLAW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 NAVY HILL RD COMMONWEALTH HEALTH CENTER
SAIPAN MP
96950
US

IV. Provider business mailing address

PMB 692 PPP BOX 10000
SAIPAN MP
96950-8900
US

V. Phone/Fax

Practice location:
  • Phone: 670-234-8950
  • Fax:
Mailing address:
  • Phone: 670-323-6529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0431
License Number StateMP

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: