MEDICARE: DR. SUSIE OZETTA TROXLER PH.D.

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	103T00000X	Psychologist	2790	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	045R4	OTHER	NC	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184627614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSIE OZETTA TROXLER PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 41105
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27404-1105
Country	:	US
Telephone Number	:	336-324-1610
Fax Number	:

Provider Business Practice Location Address
First Line	:	3409 W WENDOVER AVE STE E
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-1579
Country	:	US
Telephone Number	:	336-324-1610
Fax Number	:

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

Provider Enumeration Date	:	05/30/2005
Last Update Date	:	06/22/2021

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