Ellsworth, Susannah G
Ellsworth, Susannah G is an individual health care provider with primary practice located at 550 University Blvd , Indianapolis IN 46202-5149. She recently has only one registered license in Allopathic & Osteopathic Physicians / Radiation Oncology, which is considered as her primary health care specialty. Ellsworth, Susannah G can be contacted via phone (317) 944-2524.Contact Information
Primary practice address
550 University Blvd
Indianapolis IN 46202-5149
Phone: (317) 944-2524
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Radiation Oncology | 2085R0001X | D0071963 | Maryland |
| Allopathic & Osteopathic Physicians / Radiation Oncology | 2085R0001X | 01075059A | Indiana |
Profile Details
| NPI number | 1336283951 |
|---|---|
| LBN Legal business name | Ellsworth, Susannah G |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 16th, 2007 |
| Last updated | Mar 15th, 2016 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1336283951 | NPPES |
| Indiana | MEDICAID | 201286120 | |
| Indiana | MEDICAID | 057572100 |
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