Provider Demographics
NPI:1285624593
Name:SUSSMAN, JAMES HERBERT (D O)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:HERBERT
Last Name:SUSSMAN
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 603725
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3725
Mailing Address - Country:US
Mailing Address - Phone:828-575-2625
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:1651 GALISTEO ST
Practice Address - Street 2:SUITE 8
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4752
Practice Address - Country:US
Practice Address - Phone:505-820-9870
Practice Address - Fax:505-983-1265
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA97192207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000E5646Medicaid
NM348510103OtherMEDICARE PTAN
NM4664038OtherAETNA
NME5646Medicaid
NM4664038OtherAETNA