MEDICARE: DR. SUSAN MERMELSTEIN AU.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	231H00000X	Audiologist	78	AK

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841315124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN MERMELSTEIN AU.D.

Provider Business Mailing Address
First Line	:	3801 UNIVERSITY LAKE DRIVE, SUITE 220
Second Line	:	ANMC AUDIOLOGY DEPARTMENT
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5926
Country	:	US
Telephone Number	:	907-729-8508
Fax Number	:	907-729-1474

Provider Business Practice Location Address
First Line	:	3801 UNIVERSITY LAKE DR STE 220
Second Line	:	ANMC AUDIOLOGY DEPARTMENT
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-4658
Country	:	US
Telephone Number	:	907-729-8508
Fax Number	:	907-729-1474

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	04/28/2015

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