Provider Demographics
NPI:1043226525
Name:KOLETAR, SUSAN L (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:KOLETAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-7677
Mailing Address - Fax:614-293-5614
Practice Address - Street 1:410 W 10TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:614-293-7677
Practice Address - Fax:614-293-5614
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2024-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35053986207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0702814Medicaid
OH0702814Medicaid