Provider Demographics
NPI:1063553436
Name:CRITTENDEN, SUSAN LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LAWRENCE
Last Name:CRITTENDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 18563
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27619-8563
Mailing Address - Country:US
Mailing Address - Phone:919-782-1806
Mailing Address - Fax:919-782-1669
Practice Address - Street 1:530 NEW WAVERLY PL
Practice Address - Street 2:SUITE 200
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-7414
Practice Address - Country:US
Practice Address - Phone:919-859-5955
Practice Address - Fax:919-859-5659
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26434207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110167670OtherRAILROAD MEDICARE
0452674OtherUNITED HEALTHCARE
5121657OtherCIGNA
67051OtherMEDCOST
NC8925762Medicaid
NC25762OtherBCBS
C83387Medicare UPIN
5121657OtherCIGNA
205655BMedicare PIN