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Individual
DR. SUSAN LYNNE GONNELLA
Active
Individual
DR. SUSAN LYNNE GONNELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
176885
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101257922
NON-MEDICARE
VA
01
—
036.136110
NON-MEDICARE
IL
01
—
176885
LICENSE
NY
01
—
4301109059
NON-MEDICARE
MI
01
—
50870
NJ MEDICAL LICENSE
NJ
01
—
53903
NON-MEDICARE
CT
01
—
C130434
CA MEDICAL LICENSE
CA
01
—
D008371
NON-MEDICARE
MD
01
—
MD043243
NON-MEDICARE
DC
01
—
MD174379
NON-MEDICARE
OR
01
—
MD453535
NON-MEDICARE
PA
01
—
ME122217
NON-MEDICARE
FL
Enumeration date
09/11/2007
Last updated
01/23/2024
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