Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 267609 | NY |
Y | 207PP0204X | Pediatric Emergency Physician | 83775 | SC |
N | 2080P0205X | Pediatric Endocrinologist | 0101243923 | VA |
N | 2080P0205X | Pediatric Endocrinologist | 267609 | NY |
NPI | 1275755019 |
---|---|
Provider Name | Susan Marie Demartini |
First Address | Greenville, SC 29601-2842 |
Second Address | Greenville, SC 29605-4210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 20/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03631981 | (05) | NY |
837759 | (05) | SC |