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General NPI Number Information
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NPI Number | 1467407635
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Entity Type | Individual
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Provider Name | SUSAN MARY MANSON MD
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Gender | Female
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 11/15/2022
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Provider Practice Location Address
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Address Line | 510 TOWNE DR
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City | FAYETTEVILLE
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State | NY
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Zip | 13066-1331
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Country | US
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Telephone | 315-627-0448
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Fax | 315-627-0554
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Provider Business Mailing Address
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Address Line | 2547 LAKEFAIR DR
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City | TALLAHASSEE
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State | FL
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Zip | 32317-7002
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Country | US
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Telephone | 850-491-2326
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME100442
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 314541
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License Number State | NY
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