Healthcare Provider Details

I. General information

NPI: 1538287966
Provider Name (Legal Business Name): SUSAN LYNN BETTCHER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 E STATE ST SUITE 240
ALLIANCE OH
44601-4957
US

IV. Provider business mailing address

270 E STATE ST SUITE 240
ALLIANCE OH
44601-4957
US

V. Phone/Fax

Practice location:
  • Phone: 330-596-6500
  • Fax: 330-829-9372
Mailing address:
  • Phone: 330-596-6500
  • Fax: 330-829-9372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35.091576
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: