Provider Demographics
NPI:1548262371
Name:PSAILA, SUSAN H (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:H
Last Name:PSAILA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:HALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 N UNION ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1345
Mailing Address - Country:US
Mailing Address - Phone:585-232-8940
Mailing Address - Fax:585-232-8687
Practice Address - Street 1:30 N UNION ST
Practice Address - Street 2:SUITE 105
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1345
Practice Address - Country:US
Practice Address - Phone:585-232-8940
Practice Address - Fax:585-232-8687
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1995441207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH19881Medicare UPIN
NYRA4672Medicare ID - Type UnspecifiedMEDICARE NUMBER