MEDICARE: DR. SUSAN DIAZ KILLENBERG MD

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	2005-01097	NC

General Provider Information

NPI Number	:	1922245570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN DIAZ KILLENBERG MD

Provider Business Mailing Address
First Line	:	DEPARTMENT OF PSYCHIATRY UNIVERSITY OF NC
Second Line	:	CAMPUS BOX 7160
City	:	CHAPEL HILL
State	:	NC
Zip	:	27599-0001
Country	:	US
Telephone Number	:	919-843-7080
Fax Number	:	919-966-7225

Provider Business Practice Location Address
First Line	:	DEPARTMENT OF PSYCHIATRY UNIVERSITY OF NC
Second Line	:	CAMPUS BOX 7160
City	:	CHAPEL HILL
State	:	NC
Zip	:	27599-0001
Country	:	US
Telephone Number	:	919-843-7080
Fax Number	:	919-966-7225

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

Provider Enumeration Date	:	01/17/2009
Last Update Date	:	01/17/2009

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