Provider Demographics
NPI:1538167416
Name:KRZYZANOWSKI, SUZANNE K (MD)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:K
Last Name:KRZYZANOWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 MEMORIAL AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-2661
Mailing Address - Country:US
Mailing Address - Phone:434-200-5200
Mailing Address - Fax:
Practice Address - Street 1:2323 MEMORIAL AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2661
Practice Address - Country:US
Practice Address - Phone:434-200-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010022746Medicaid
VA010289467Medicaid
VA010321557Medicaid
VA437347OtherANTHEM
VA437347OtherANTHEM
VV1253AMedicare PIN
010728C80Medicare PIN
BK5812830OtherDEA
VA018044C18Medicare PIN