Healthcare Provider Details

I. General information

NPI: 1487620589
Provider Name (Legal Business Name): SUSAN P OPAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4164 ROUTE 2
CROPSEYVILLE NY
12052
US

IV. Provider business mailing address

711 TROY SCHENECTADY RD SUITE 201
LATHAM NY
12110-2442
US

V. Phone/Fax

Practice location:
  • Phone: 518-213-0450
  • Fax: 518-279-1716
Mailing address:
  • Phone: 518-213-0478
  • Fax: 518-782-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number255711
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number23525
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: