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General NPI Number Information
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NPI Number | 1487604369
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Entity Type | Individual
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Provider Name | SUZANNE D CONNOLLY MD
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Gender | Female
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 05/14/2009
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Provider Practice Location Address
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Address Line | 805 COLUMBIA RD SUITE 102
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City | WESTLAKE
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State | OH
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Zip | 44145-1487
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Country | US
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Telephone | 440-808-1925
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Fax | 440-808-1926
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Provider Business Mailing Address
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Address Line | 805 COLUMBIA RD SUITE 102
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City | WESTLAKE
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State | OH
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Zip | 44145-1487
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Country | US
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Telephone | 440-808-1925
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Fax | 440-808-1926
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35086814
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License Number State | OH
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