Provider Demographics
NPI:1346360146
Name:CHA, SUSAN H (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:H
Last Name:CHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 OAK GROVE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2520
Mailing Address - Country:US
Mailing Address - Phone:925-296-7150
Mailing Address - Fax:925-296-7171
Practice Address - Street 1:1601 YGNACIO VALLEY RD
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3122
Practice Address - Country:US
Practice Address - Phone:925-296-7150
Practice Address - Fax:925-296-7171
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1125092085R0202X
PAMT1856552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFP604NMedicare PIN
CAFP604IMedicare PIN
CAFP604JMedicare PIN
CAFP604VMedicare PIN
CAFP604GMedicare PIN
CAFP604FMedicare PIN
CAFP604KMedicare PIN
CAFP604RMedicare PIN
CAFP604ZMedicare PIN
CAFP604HMedicare PIN
CAFP604UMedicare PIN
CAFP604WMedicare PIN
CAFP604OMedicare PIN
CAFP604SMedicare PIN
CAFP604LMedicare PIN
CAFP604XMedicare PIN
CAFP604QMedicare PIN
CAFP604MMedicare PIN
CAFP604PMedicare PIN
CAFP604TMedicare PIN
CAFP604YMedicare PIN