Provider Demographics
NPI:1073577326
Name:DEAN, SUSAN JANE (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:JANE
Last Name:DEAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DASHER WOUND CARE CENTER
Mailing Address - Street 2:924 N. HOWE STREET
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461
Mailing Address - Country:US
Mailing Address - Phone:910-457-3800
Mailing Address - Fax:907-745-7570
Practice Address - Street 1:DASHER WOUND CARE CENTER
Practice Address - Street 2:924 N. HOWE STREET
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461
Practice Address - Country:US
Practice Address - Phone:910-457-3800
Practice Address - Fax:907-745-7570
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK73002086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8928018Medicaid
AKMD9490Medicaid
NC8928018Medicaid
NCF35000Medicare UPIN
AKMD9490Medicaid