Provider Demographics
NPI:1912931858
Name:SYPHARD, SUSAN S (DO)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:S
Last Name:SYPHARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 601376
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1376
Mailing Address - Country:US
Mailing Address - Phone:704-283-8193
Mailing Address - Fax:704-283-7252
Practice Address - Street 1:613 E ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5124
Practice Address - Country:US
Practice Address - Phone:704-283-8193
Practice Address - Fax:704-283-7252
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101420207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913498Medicaid
NC13498OtherBCBS
NC13498OtherBCBS
NCH93239Medicare UPIN