Provider Demographics
NPI:1316142672
Name:SUSSMAN, KATIE GOONAN (MD)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:GOONAN
Last Name:SUSSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:222 ALEXANDER ST
Mailing Address - Street 2:SUITE 4100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-4005
Mailing Address - Country:US
Mailing Address - Phone:585-922-8230
Mailing Address - Fax:585-922-8260
Practice Address - Street 1:222 ALEXANDER ST
Practice Address - Street 2:SUITE 4100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-4005
Practice Address - Country:US
Practice Address - Phone:585-922-8230
Practice Address - Fax:585-922-8260
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2015-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY269979208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD036992600Medicaid
MD036992600Medicaid