Provider Demographics
NPI:1285758433
Name:MORRISON, SUSAN MATHISON (MD)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MATHISON
Last Name:MORRISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6310 SAN VICENTE BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5471
Mailing Address - Country:US
Mailing Address - Phone:323-933-6330
Mailing Address - Fax:323-933-6334
Practice Address - Street 1:6310 SAN VICENTE BLVD STE 330
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5471
Practice Address - Country:US
Practice Address - Phone:323-933-6330
Practice Address - Fax:323-933-6334
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62028207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G91586Medicare UPIN