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Organization

TED L SUSSMAN

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TED LAWRENCE SUSSMAN MD (OWNER)
(207) 532-7671
Entity
Organization

Contact information

Practice address
20 HARTFORD ST, HOULTON, ME 04730-1891
(207) 532-7671
Mailing address
PO BOX 695, HOULTON, ME 04730-0695
(207) 532-7671
(207) 532-7671

Taxonomy

Speciality
Code
Description
License number
State
171R00000X
Interpreter
Primary
010269
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
293380099
ME
01
ME1883
MEDICARE-PACER CLINIC
ME
Enumeration date
08/18/2008
Last updated
08/18/2008
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