Healthcare Provider Details

I. General information

NPI: 1205820529
Provider Name (Legal Business Name): SUSAN ELLEN CRAPES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN E. CRAPES M.D.

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 HARDING ST
ATHENS OH
45701-1662
US

IV. Provider business mailing address

PO BOX 2605
ATHENS OH
45701-5405
US

V. Phone/Fax

Practice location:
  • Phone: 740-592-0585
  • Fax:
Mailing address:
  • Phone: 740-592-0585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number35039946C
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: