Provider Demographics
NPI:1811149081
Name:ALDEN, SUSAN LESLIE (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LESLIE
Last Name:ALDEN
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 1:2575 REGAL RIVER RD
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-8307
Mailing Address - Country:US
Mailing Address - Phone:813-310-3960
Mailing Address - Fax:813-684-5094
Practice Address - Street 1:2575 REGAL RIVER RD
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-8307
Practice Address - Country:US
Practice Address - Phone:813-310-3960
Practice Address - Fax:813-684-5094
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-18
Last Update Date:2008-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057413208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0057413OtherMEDICAL LICENSE
FLE58288Medicare UPIN