MEDICARE: DR. SUSAN C MASSICK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	35078051	OH

General Provider Information

NPI Number	:	1144202490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN C MASSICK MD

Provider Business Mailing Address
First Line	:	700 ACKERMAN RD STE 2120
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43202-1559
Country	:	US
Telephone Number	:	614-293-1707
Fax Number	:	614-947-1716

Provider Business Practice Location Address
First Line	:	6100 N HAMILTON RD
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-2062
Country	:	US
Telephone Number	:	614-293-1707
Fax Number	:	614-293-1716

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	07/02/2024

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