Provider Demographics
NPI:1306093158
Name:HARLAN, SUSAN RIDER (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:RIDER
Last Name:HARLAN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
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Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-8541
Mailing Address - Fax:323-442-8755
Practice Address - Street 1:1500 SAN PABLO ST FL 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-442-8541
Practice Address - Fax:323-442-8755
Is Sole Proprietor?:No
Enumeration Date:2008-08-23
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1099612085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology