Provider Demographics
NPI:1215256599
Name:ADHAM, SUSAN LYLA (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYLA
Last Name:ADHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4053 LONE TREE WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-6210
Mailing Address - Country:US
Mailing Address - Phone:925-756-3400
Mailing Address - Fax:925-757-6387
Practice Address - Street 1:4053 LONE TREE WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-6210
Practice Address - Country:US
Practice Address - Phone:925-756-3400
Practice Address - Fax:925-757-6387
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2017-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA108068208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA108068OtherSTATE LICENSE