Provider Demographics
NPI:1538233184
Name:PICA, SUZANNE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:MARIE
Last Name:PICA
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 1:505 SHOPPERS DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391
Mailing Address - Country:US
Mailing Address - Phone:859-744-1358
Mailing Address - Fax:859-744-3144
Practice Address - Street 1:505 SHOPPERS DR
Practice Address - Street 2:SUITE 2
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391
Practice Address - Country:US
Practice Address - Phone:859-744-1358
Practice Address - Fax:859-744-3144
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28114208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000050542OtherANTHEM BLUE CROSS
KY64281140Medicaid
F31701Medicare UPIN
KY1581001Medicare ID - Type Unspecified