Provider Demographics
NPI:1972686723
Name:CHAMPION, SUSAN ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:CHAMPION
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Gender:F
Credentials:MD
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Mailing Address - Street 1:ST. MARY'S REHABILITATION CENTER FOR CHILDREN
Mailing Address - Street 2:15 VALLEY SPRING ROAD
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562
Mailing Address - Country:US
Mailing Address - Phone:914-333-7061
Mailing Address - Fax:914-333-7175
Practice Address - Street 1:ST. MARY'S REHABILITATION CENTER FOR CHILDREN
Practice Address - Street 2:15 VALLEY SPRING ROAD
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562
Practice Address - Country:US
Practice Address - Phone:914-333-7061
Practice Address - Fax:914-333-7175
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY166997208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD92029Medicare UPIN