Provider Demographics
NPI:1699895730
Name:BARTOL-KRUEGER, SUZANNE M (MD)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:M
Last Name:BARTOL-KRUEGER
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 1:475 IRVING AVE, SUITE 108
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-3210
Mailing Address - Country:US
Mailing Address - Phone:315-671-0070
Mailing Address - Fax:315-475-0620
Practice Address - Street 1:475 IRVING AVE, SUITE 108
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-3210
Practice Address - Country:US
Practice Address - Phone:315-671-0070
Practice Address - Fax:315-475-0620
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242653-1174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB4635Medicare PIN