MEDICARE: SUSAN SHERLOCK LOCKE 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	54961	OH

General Provider Information

NPI Number	:	1518059187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN SHERLOCK LOCKE M.D.

Provider Business Mailing Address
First Line	:	6133 ROCKSIDE RD
Second Line	:	SUITE 207
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-2223
Country	:	US
Telephone Number	:	216-520-5969
Fax Number	:	216-520-5098

Provider Business Practice Location Address
First Line	:	6133 ROCKSIDE RD
Second Line	:	SUITE 207
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-2223
Country	:	US
Telephone Number	:	216-520-5969
Fax Number	:	216-520-5098

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

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	07/08/2007

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