KENNETH ROGER SUSMAN (NPI# 1962551119) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962551119 |
| Entity Type | Individual |
| Full Name | KENNETH ROGER SUSMAN |
| Credential | M.D. |
| Practice Address |
510 Cypress St Suite B Fort Bragg CA 95437-5411 |
| Practice Telephone | 7079611972 |
| Practice Fax Number | 7079611978 |
| Mailing Telephone | 7079611972 |
| Mailing Fax Number | 7079611978 |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | G679520 | CA | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891720645 | Kenneth H Susman | Podiatrist | 5901 W Olympic Blvd, Suite 509, Los Angeles, CA 90036-4667 | 2006-07-11 |
| Street Address |
510 CYPRESS ST SUITE B |
| City | FORT BRAGG |
| State | CA |
| Zip Code | 95437-5411 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881688380 | Lynette Kline | Optometrist | 510 Cypress St, Ste A, Fort Bragg, CA 95437-5411 | 2005-09-12 |
| 1851837454 | Breon Maree Henderson | Registered Nurse | 510 Cypress St, Ste D, Fort Bragg, CA 95437-5411 | 2017-01-06 |
| 1982917571 | Jason David Moore | Acupuncturist | 510 Cypress St, Suite C, Fort Bragg, CA 95437-5411 | 2010-07-23 |
| 1912157264 | Andrea Lynn Shafir | Acupuncturist | 510 Cypress St, Suite C200, Fort Bragg, CA 95437-5411 | 2008-09-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902357437 | Mendocino Coast Hospitality Center | Community/Behavioral Health | 137 E. Oak Street, Fort Bragg, CA 95437 | 2016-10-19 |
| 1144604570 | Erin Paul | Community Health Worker | 474 South Franklin Street, Fort Bragg, CA 95437 | 2015-07-15 |
| 1508125790 | Joel Macgregor Green | Marriage & Family Therapist | 331- G Redwood Ave., Fort Bragg, CA 95437 | 2012-05-09 |
| 1013244102 | Jenna Glasscock | Counselor | 331 E Redwood Ave, Ste E, Fort Bragg, CA 95437 | 2009-11-10 |
| 1770819641 | Patrick Lenaghan | Emergency Medicine | 707 River Dr, Fort Bragg, CA 95437 | 2009-10-27 |
| 1043455827 | M. Lee Baker | Dentist | 890 River Dr, Fort Bragg, CA 95437 | 2008-12-09 |
| 1528250495 | Christine Anne Samas | Social Worker | 656a Harrison St., Fort Bragg, CA 95437 | 2007-08-15 |
| 1083822811 | Katharine L. White | Marriage & Family Therapist | 137 E Oak Street, Fort Bragg, CA 95437 | 2007-05-17 |
| 1053525873 | Marty Christine Johnson | Marriage & Family Therapist | 331 E. Redwood Ave, Fort Bragg, CA 95437 | 2007-05-10 |
| 1528114741 | Kate Teresa Donohue | Psychologist | 19201 Noyo Acres Dr, Fort Bragg, CA 95437 | 2007-01-29 |
| Find all providers in zip 95437 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770747750 | Jeffery Alan Dolbeer | Specialist | 2817 Reilly St, Womack Army Medical Center, Fort Bragg, NC 28310-7324 | 2008-07-18 |
| 1215094453 | Kimberly Evans Moser | Specialist | Womack Army Medical Ctr, 2817 Reilly Rd, Fort Bragg, NC 28310-7301 | 2007-01-03 |
| 1780757070 | Robert W Ryder | Specialist | 205 South St, Fort Bragg, CA 95437-5540 | 2006-11-16 |
| 1205928660 | Charles C Jenkins | Specialist | 700 River Dr, Fort Bragg, CA 95437-5403 | 2006-09-29 |
| 1831130657 | Teresa White | Specialist | Robinson Health Clinic, Fort Bragg, NC 28310-0001 | 2006-06-10 |
| 1629079926 | Deogracia Quinones | Specialist | Womack Army Medical Ctr, Stop A, 2817 Reilly Road, Fort Bragg, NC 28310-0001 | 2005-08-09 |
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| 1417572462 | Sarah Velez | Specialist | 1001 Potrero Ave Rm 7g19, San Francisco, CA 94110-3518 | 2020-06-15 |
| 1295350668 | Bette Graff | Specialist | 4148 10th St, Riverside, CA 92501-3110 | 2020-06-11 |
| 1114541463 | Serena Mink | Specialist | 100 Park Plz Apt 407, San Diego, CA 92101-6710 | 2020-06-02 |
| 1811510043 | Michael J Kodrich | Specialist | 40555 California Oaks Rd, Murrieta, CA 92562-5723 | 2020-05-21 |
| Find all providers with the same taxonomy | ||||
| City | FORT BRAGG |
| Zip Code | 95437 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.