Gannon, Susan M.
Gannon, Susan M. is an individual health care provider with primary practice located at 455 Patroon Creek Blvd. Suite 101, Albany NY 12206. She recently has only one registered license in Other Service Providers / Specialist, which is considered as her primary health care specialty. Gannon, Susan M. can be contacted via phone (518) 438-0505.Contact Information
Primary practice address
455 Patroon Creek Blvd. Suite 101
Albany NY 12206
Phone: (518) 438-0505
Fax: (518) 438-4517
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 234913-1 | New York |
Profile Details
| NPI number | 1063471209 |
|---|---|
| LBN Legal business name | Gannon, Susan M. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 17th, 2006 |
| Last updated | Jan 29th, 2014 - about 11 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 | 1063471209 | NPPES |
| New York | MEDICAID | 02685936 |
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