Healthcare Provider Details

I. General information

NPI: 1609824861
Provider Name (Legal Business Name): SUZANNE B KAISER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E FERRELL ST
SOUTH HILL VA
23970-2104
US

IV. Provider business mailing address

PO BOX 155 202 EAST FERRELL STREET
SOUTH HILL VA
23970-0155
US

V. Phone/Fax

Practice location:
  • Phone: 434-447-3899
  • Fax: 434-447-7120
Mailing address:
  • Phone: 434-447-3899
  • Fax: 434-447-7120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101046990
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: