Provider Demographics
NPI:1285747618
Name:SUSANKA, MATTHEW JAMES (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JAMES
Last Name:SUSANKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:77 CADILLAC DR
Mailing Address - Street 2:STE 230
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-5480
Mailing Address - Country:US
Mailing Address - Phone:916-920-2082
Mailing Address - Fax:916-920-1430
Practice Address - Street 1:77 CADILLAC DR
Practice Address - Street 2:230
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-5480
Practice Address - Country:US
Practice Address - Phone:916-920-2082
Practice Address - Fax:916-920-2082
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2016-07-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG77856207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTG66099Medicare UPIN