Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 305311 | NY |
N | 207N00000X | Dermatologist | 6190-851 | WI |
NPI | 1003202896 |
---|---|
Provider Name | Susan Pei |
First Address | Madison, WI 53792-0001 |
Second Address | Buffalo, NY 14203-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2015 |
Last Update Date | 02/02/2021 |