Provider Demographics
NPI:1699917674
Name:WIEPERT, SUSAN LEE (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LEE
Last Name:WIEPERT
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 1:954 ESCARPMENT DR
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-2022
Mailing Address - Country:US
Mailing Address - Phone:716-523-7664
Mailing Address - Fax:
Practice Address - Street 1:700 CENTER ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-1706
Practice Address - Country:US
Practice Address - Phone:716-205-3282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256527208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics