Provider Demographics
NPI:1568525970
Name:FROMMEYER, SUSAN BETH (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:BETH
Last Name:FROMMEYER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 EAST COLLEGE STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478
Mailing Address - Country:US
Mailing Address - Phone:931-292-6644
Mailing Address - Fax:931-292-6648
Practice Address - Street 1:1275 EAST COLLEGE STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:DULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478
Practice Address - Country:US
Practice Address - Phone:931-292-6644
Practice Address - Fax:931-292-6648
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ76927207V00000X
KY38437207VX0000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64077357Medicaid
KY64077357Medicaid
0798201Medicare ID - Type Unspecified