MEDICARE: DR. SUSAN VETTICHIRA 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	208100000X	Physical Medicine & Rehabilitation Physician	ME85242	FL
2	208100000X	Physical Medicine & Rehabilitation Physician	2008-01112	NC

General Provider Information

NPI Number	:	1265403760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN VETTICHIRA MD

Provider Business Mailing Address
First Line	:	147 HWY 24
Second Line	:	HESTRON PLAZA, SUITE 102
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-8998
Country	:	US
Telephone Number	:	252-726-4000
Fax Number	:	252-726-2530

Provider Business Practice Location Address
First Line	:	147 HIGHWAY 24
Second Line	:	HESTRON PLAZA, SUITE 102
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-4306
Country	:	US
Telephone Number	:	252-726-4000
Fax Number	:	252-726-2530

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

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	04/08/2011

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