MEDICARE: MICHAEL SUSCO M.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	2084P0800X	Psychiatry Physician	168413-1	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	:	1285609131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL SUSCO M.D.

Provider Business Mailing Address
First Line	:	241 NORTH RD
Second Line	:
City	:	POUGHKEEPSIE
State	:	NY
Zip	:	12601-1154
Country	:	US
Telephone Number	:	845-431-8853
Fax Number	:

Provider Business Practice Location Address
First Line	:	1386 HATHAWAY DR
Second Line	:	SUITE A
City	:	FARMINGTON
State	:	NY
Zip	:	14425-8973
Country	:	US
Telephone Number	:	585-396-4190
Fax Number	:

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	03/16/2017

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