Individual
SUSAN LYN KOELLIKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 444-5174
(401) 921-9212
Mailing address
125 METRO CENTER BLVD STE 2000, WARWICK, RI 02886-1785
(401) 432-2520
(401) 921-9212
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
154179
MA
2085R0202X
Diagnostic Radiology Physician
Primary
MD08865
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000001988
NHPRI
—
01
—
003111482
CT MED ASSISTANCE
—
01
—
005220
BLUECHIP
—
01
—
007004713
HOSPITAL PIN
—
01
—
007004715
MEDICARE
—
01
—
008865
BLUESHIELD
—
01
—
1600203
UNITEDHEALTHPLANS
—
01
—
240171
RJHPILGRIM
—
01
—
300067448
RAILROAD MEDICARE
—
01
—
3199894
MASSMEDICAID
—
01
—
403111
TUFTS
—
01
—
7004715
RIMEDICALASSISTANCE
—
01
—
720053201
CIGNA
—
Enumeration date
10/13/2005
Last updated
03/15/2024
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