Organization
MARK D SUSKI MD A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK D SUSKI M.D. (PRESIDENT)
(805) 494-3330
Entity
Organization
Contact information
Practice address
2220 LYNN RD, SUITE 102, THOUSAND OAKS, CA 91360-1904
(805) 494-3330
(805) 494-1255
Mailing address
2220 LYNN RD, SUITE 102, THOUSAND OAKS, CA 91360-1904
(805) 494-3330
(805) 494-1255
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
G76464
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G764640
BLUE SHIELD PIN
CA
01
—
G76464
BLUE CROSS PIN
CA
Enumeration date
11/09/2006
Last updated
11/24/2009
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