Healthcare Provider Details

I. General information

NPI: 1710042387
Provider Name (Legal Business Name): SUSAN DOWNER FOREMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 CONFERENCE DR
GREENVILLE NC
27858-5971
US

IV. Provider business mailing address

203 WILLIAMSBURG DR
GREENVILLE NC
27858-6327
US

V. Phone/Fax

Practice location:
  • Phone: 252-756-4899
  • Fax: 252-756-5141
Mailing address:
  • Phone: 252-355-5997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number23843
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: