DR. SUSAN P. ETHERIDGE (NPI# 1952480527) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952480527 |
| Entity Type | Individual |
| Full Name | DR. SUSAN P. ETHERIDGE |
| Credential | MD |
| Practice Address |
81 N Mario Capecchi Dr Salt Lake City UT 84113-1125 |
| Mailing Address |
Po Box 413021 Salt Lake City UT 84141-3021 |
| Practice Telephone | 8012133599 |
| Practice Fax Number | 8012137778 |
| Mailing Telephone | 8012133900 |
| Mailing Fax Number | 8015853655 |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2016-09-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RC0001X |
Internal Medicine Specialization: Clinical Cardiac Electrophysiology |
8186 | AK | Allopathic & Osteopathic Physicians |
| Y | 207RC0001X |
Internal Medicine Specialization: Clinical Cardiac Electrophysiology |
273593-1205 | UT | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | 8186 | AK | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | 273593-1205 | UT | Allopathic & Osteopathic Physicians |
| N | 2080P0202X |
Pediatrics Specialization: Pediatric Cardiology |
8389 | AK | Allopathic & Osteopathic Physicians |
| N | 2080P0202X |
Pediatrics Specialization: Pediatric Cardiology |
273593-120 | UT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | 1018632 | 05 |
| Street Address |
81 N MARIO CAPECCHI DR |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84113-1125 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922012251 | Jeffrey Marvin Dalley | Social Worker | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2006-07-29 |
| 1255946588 | Sarah Elizabeth Roberts | Dietitian, Registered | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2020-09-14 |
| 1144835885 | Rachel Coffey | Social Worker | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2020-09-10 |
| 1457965865 | Mallory Caitlin Kidwell | Clinic/Center | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2020-09-02 |
| 1063021699 | Sara Stevenson | Dietitian, Registered | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2020-07-29 |
| 1780292318 | Katherine Ruesch | Nurse Practitioner | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2020-07-20 |
| 1124646062 | Nathaniel Edward Hayward | Student in an Organized Health Care Education/Training Program | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2020-07-07 |
| 1780209544 | Paul Clark Bluth | Student in an Organized Health Care Education/Training Program | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2020-06-08 |
| 1477177939 | Kristen Wong | Genetic Counselor, MS | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2020-06-01 |
| 1891316170 | Brianna Dougall | Registered Nurse | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2020-04-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386111060 | Melissa Marie Dixon | Psychologist | Primary Children's Hospital Outpatient Services, 81 South Mario Capecchi Drive, Salt Lake City, UT 84113 | 2018-10-31 |
| 1366965618 | Ashley Stuart | Psychologist | 44 North Mario Capecchi Drive, Salt Lake City, UT 84113 | 2017-07-19 |
| 1487945135 | Justin C Wheeler | Pediatrics | 81 N Mario Capecchi Dr Fl 4, Salt Lake City, UT 84113 | 2011-04-29 |
| 1154612117 | Dana Boucek | Pediatrics | 100 North Mario Capecchi Dr., Primary Children's, Salt Lake City, UT 84113 | 2011-04-26 |
| 1285959502 | Anna Katherine Eyre Ermarth | Pediatrics | 81 Mario Capecchi, Salt Lake City, UT 84113 | 2010-03-30 |
| 1457682072 | Elizabeth K Cho | Nurse Practitioner | 100 North Mario Cappechi Dr., Salt Lake City, UT 84113 | 2010-01-21 |
| 1528290848 | Nancy Crandell Brown | Nurse Practitioner | 100 North Mario Cappechi Drive, Salt Lake City, UT 84113 | 2009-08-20 |
| 1679708481 | Primary Children's Medical Center | General Acute Care Hospital | 100 No. Mario Capecchi Drive, Salt Lake, UT 84113 | 2009-05-22 |
| 1467697235 | Tara Hook | Physical Therapist | 100 North Mario Capecchi Dr, Salt Lake City, UT 84113 | 2008-12-09 |
| 1144474768 | Jennifer K Workman | Pediatrics | 100 N Mario Capecchi Drive, Pediatric Crtical Care, Primary Children's Hospital, Salt Lake City, UT 84113 | 2008-11-10 |
| Find all providers in zip 84113 | ||||
| Taxonomy Code | 207RC0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Clinical Cardiac Electrophysiology |
| A field of special interest within the subspecialty of cardiovascular disease, specialty of Internal Medicine, which involves intricate technical procedures to evaluate heart rhythms and determine appropriate treatment for them. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851795652 | University of Utah Adult Services | Internal Medicine | 50 North Medical Drive, Salt Lake City, UT 84132 | 2014-10-22 |
| 1164842415 | Karnika Ayinapudi | Internal Medicine | 30 N 1900 E Rm 4a100, Salt Lake City, UT 84132-0002 | 2014-04-24 |
| 1992967335 | Nischala Nannapaneni | Internal Medicine | 1160 E 3900 S Ste 2000, Salt Lake City, UT 84124-1236 | 2008-06-26 |
| 1518048305 | Travis Scott Wall | Internal Medicine | 50 N Medical Dr, Salt Lake City, UT 84132-0001 | 2006-10-18 |
| 1790866580 | Roger A. Freedman | Internal Medicine | 100 N Medical Dr, Salt Lake City, UT 84113-1103 | 2006-10-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497078786 | Seongwook Han | Internal Medicine | 1055 N 500 W, Ste 101, Provo, UT 84604-3305 | 2010-03-01 |
| 1952569931 | Yonathan Melman | Internal Medicine | 4403 Harrison Blvd, Ste 3450, Ogden, UT 84403-3271 | 2008-05-27 |
| 1417025628 | Michael Cutler | Internal Medicine | 5169 S Cottonwood St, Ste 510, Murray, UT 84107-6767 | 2006-12-04 |
| 1366413924 | John H. Jentzer | Internal Medicine | 1380 E Medical Center Dr, Suite 1500, St George, UT 84790-2123 | 2006-01-31 |
| City | SALT LAKE CITY |
| Zip Code | 84113 |
Please comment or provide details below to improve the information on DR. SUSAN P. ETHERIDGE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.