Individual
ELISABETH A SUSANKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1508 DIVISION ST, SUITE 205, OREGON CITY, OR 97045-1582
(503) 657-1071
(503) 657-3321
Mailing address
7650 SW BEVELAND RD, SUITE 200, PORTLAND, OR 97223-8692
(503) 657-1071
(503) 657-3321
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD18896
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150154
—
OR
01
—
R114529
MEDICARE PTAN
OR
Enumeration date
05/01/2006
Last updated
06/24/2016
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