Provider Demographics
NPI:1710042387
Name:FOREMAN, SUSAN DOWNER (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:DOWNER
Last Name:FOREMAN
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 1:203 WILLIAMSBURG DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-6327
Mailing Address - Country:US
Mailing Address - Phone:252-355-5997
Mailing Address - Fax:
Practice Address - Street 1:925 CONFERENCE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5971
Practice Address - Country:US
Practice Address - Phone:252-756-4899
Practice Address - Fax:252-756-5141
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC238432080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
562165173OtherFED IDENTIFICATION NUMBER
NC893308AMedicaid
NC3308AOtherBCBS PROVIDER NUMBER
NC3308AOtherBCBS PROVIDER NUMBER
NC893308AMedicaid