Provider Demographics
NPI:1366414054
Name:MANN-SWEENEY, SUSAN (MD)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:MANN-SWEENEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3377 RIVERBEND DR.
Mailing Address - Street 2:PEDIATRICS
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-8004
Mailing Address - Country:US
Mailing Address - Phone:541-222-8500
Mailing Address - Fax:541-222-6435
Practice Address - Street 1:3377 RIVERBEND DR.
Practice Address - Street 2:PEDIATRICS
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477
Practice Address - Country:US
Practice Address - Phone:541-222-8500
Practice Address - Fax:541-222-6435
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD172023208000000X
FLME96215208000000X
AZ19006208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ288242003OtherAPIPA INSURANCE
AZ288242Medicaid
AZ1Z6556OtherHEALTHNET
AZ2882420OtherDEPT OF ECONOMIC SECURITY
AZ019006OtherMAYO INSURANCE
AZ860224023OtherUNITED HEALTHCARE
AZ00014248OtherBANNER HEALTH PLAN
AZAZ0823650OtherBLUE CROSS BLUE SHIELD
FL276325700Medicaid
AZ860224023OtherUNITED HEALTHCARE