MEDICARE: JONATHAN SUSSMAN

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	208800000X	Urology Physician	35.155942	OH

General Provider Information

NPI Number	:	1750919387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN SUSSMAN

Provider Business Mailing Address
First Line	:	10220 ALLIANCE RD
Second Line	:
City	:	BLUE ASH
State	:	OH
Zip	:	45242-4710
Country	:	US
Telephone Number	:	513-841-7800
Fax Number	:

Provider Business Practice Location Address
First Line	:	10220 ALLIANCE RD
Second Line	:
City	:	BLUE ASH
State	:	OH
Zip	:	45242-4710
Country	:	US
Telephone Number	:	513-841-7800
Fax Number	:

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

Provider Enumeration Date	:	03/30/2020
Last Update Date	:	04/27/2026

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Directions to “ JONATHAN SUSSMAN ” Practice Location

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