MEDICARE: SUSAN M SANTRY 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	207R00000X	Internal Medicine Physician	1705661	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154300911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN M SANTRY MD

Provider Business Mailing Address
First Line	:	PO BOX 8503
Second Line	:
City	:	PELHAM
State	:	NY
Zip	:	10803-8503
Country	:	US
Telephone Number	:	203-249-6767
Fax Number	:	203-531-1901

Provider Business Practice Location Address
First Line	:	127E LINCOLN AVE
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10552-3208
Country	:	US
Telephone Number	:	203-249-6767
Fax Number	:	203-531-1901

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	09/23/2015

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Directions to “ SUSAN M SANTRY MD” Practice Location

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