Provider Demographics
NPI:1962427948
Name:SCHOMMER, SUSAN S (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:S
Last Name:SCHOMMER
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 1:194 SEACLIFF DR
Mailing Address - Street 2:
Mailing Address - City:SHELL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-1715
Mailing Address - Country:US
Mailing Address - Phone:805-773-1453
Mailing Address - Fax:
Practice Address - Street 1:194 SEACLIFF DR
Practice Address - Street 2:
Practice Address - City:SHELL BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-1715
Practice Address - Country:US
Practice Address - Phone:805-773-1453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-7938208600000X
NM2001-93208600000X
CAC50650208600000X
HIMD-13527EFF208600000X
ME018328208600000X
GA063153208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0661234Medicaid
OH0661234Medicaid
OHSC0594392Medicare ID - Type Unspecified