Healthcare Provider Details

I. General information

NPI: 1538569165
Provider Name (Legal Business Name): DR. SUSAN VANMETER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MOORE DR ATTN: 5.4600
RTP NC
27709-0143
US

IV. Provider business mailing address

5 MOORE DR ATTN: 5.4600
RTP NC
27709-0143
US

V. Phone/Fax

Practice location:
  • Phone: 919-483-1273
  • Fax:
Mailing address:
  • Phone: 919-483-1273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number9500750
License Number StateNC

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: