=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770565335
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN C GALBRAITH MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2005
-----------------------------------------------------
Last Update Date | 06/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33 W RAHN RD
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45429-2219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-433-8990
-----------------------------------------------------
Fax | 937-433-8691
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33 W RAHN RD
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45429-2219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-433-8990
-----------------------------------------------------
Fax | 937-433-8691
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | 44502
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | 35070085
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------