Provider Demographics
NPI:1902801228
Name:PATTON, SUZANNE E (MD, PHD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:E
Last Name:PATTON
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-7009
Mailing Address - Country:US
Mailing Address - Phone:276-469-4200
Mailing Address - Fax:276-469-4249
Practice Address - Street 1:2202 N JOHN B DENNIS HWY STE 100
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-5904
Practice Address - Country:US
Practice Address - Phone:423-578-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239507207RH0003X
GA051709174400000X
TN40566207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00959791AMedicaid
GA00959791BMedicaid
GA00959791CMedicaid
GA00959791AMedicaid
VAVVA471BMedicare PIN
TN103I831407Medicare PIN
TN3337051Medicare PIN
TN103I832859Medicare PIN