Provider Demographics
NPI:1285887901
Name:SUSLOV, KATHRYN (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:SUSLOV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:893 SIR FRANCIS DRAKE BLVD
Mailing Address - Street 2:THERAPEUTIC BODYWORK CENTER
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-1916
Mailing Address - Country:US
Mailing Address - Phone:415-723-6555
Mailing Address - Fax:
Practice Address - Street 1:893 SIR FRANCIS DRAKE BLVD
Practice Address - Street 2:THERAPEUTIC BODYWORK CENTER
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-1916
Practice Address - Country:US
Practice Address - Phone:415-723-6555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-25
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2480382083P0901X
CA1303912083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine