MEDICARE: SUSAN R EHRENTHAL 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	208100000X	Physical Medicine & Rehabilitation Physician	78318	MA

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	:	1578531182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN R EHRENTHAL M.D.

Provider Business Mailing Address
First Line	:	311 SERVICE RD
Second Line	:
City	:	EAST SANDWICH
State	:	MA
Zip	:	02537-1370
Country	:	US
Telephone Number	:	508-833-4172
Fax Number	:	508-833-4202

Provider Business Practice Location Address
First Line	:	311 SERVICE RD
Second Line	:
City	:	EAST SANDWICH
State	:	MA
Zip	:	02537-1370
Country	:	US
Telephone Number	:	508-833-4172
Fax Number	:	508-833-4202

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	01/18/2022

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