Provider Demographics
NPI:1487733952
Name:LEWIN, SUSAN ORA (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ORA
Last Name:LEWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ORA
Other - Last Name:LEWIN-OPITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:DIV MEDICAL GENETICS 2C412 SOM
Mailing Address - Street 2:SALT LAKE CITY
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0001
Mailing Address - Country:US
Mailing Address - Phone:801-581-8943
Mailing Address - Fax:801-585-7252
Practice Address - Street 1:100 N MEDICAL DR
Practice Address - Street 2:SALT LAKE CITY
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1103
Practice Address - Country:US
Practice Address - Phone:801-581-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT341485-1205207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)