Provider Demographics
NPI:1699066597
Name:MATHIAS, SUSANNA DARCIE (MD)
Entity type:Individual
Prefix:
First Name:SUSANNA
Middle Name:DARCIE
Last Name:MATHIAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSANNA
Other - Middle Name:DARCIE
Other - Last Name:BOYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:55 ARCH ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1423
Mailing Address - Country:US
Mailing Address - Phone:330-375-3315
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195
Practice Address - Country:US
Practice Address - Phone:216-445-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
OH35.133022208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program