Suzanne Grace Amidon Magro, D.O.

Key facts

NPI: 1407941198
Entity type: Individual (NPI type 1)
Primary specialty: Emergency Medicine Physician 207P00000X
License: 34-005775 (OH)
Practice address: 715 S Taft Ave
Fremont, OH 43420-3200
Phone: (419) 332-7321
NPI assigned: Oct 4, 2006
Sex: Female
Sole proprietor: No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Bowling Green State University Family Medicine Physician · Bowling Green, OH · NPI 1699707687

NPD (past)
Memorial Emergency Specialists Inc. Emergency Medicine Physician · Fremont, OH · NPI 1114028172

NPD (past) EMERGENCY MEDICINE

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Osteopathy

State licenses

License	State	Type	Specialty
34-005775	OH	MD	Emergency Medicine Physician

Practice roles

Organization	Specialty	Status	New patients
Bowling Green State University		Past	Accepting new patients
Memorial Emergency Specialists Inc.	Emergency Medicine	Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Emergency Medicine Physician	207P00000X	34-005775	OH	Yes

Addresses

Primary practice location

715 S Taft Ave
Fremont, OH 43420-3200

Mailing address

11 Ponds Side Dr
Fremont, OH 43420-2677
Phone (419) 333-0981

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407941198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 PONDS SIDE DR",
            "city": "FREMONT",
            "state": "OH",
            "postal_code": "434202677",
            "telephone_number": "419-333-0981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 S TAFT AVE",
            "city": "FREMONT",
            "state": "OH",
            "postal_code": "434203200",
            "telephone_number": "419-332-7321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMIDON MAGRO",
        "first_name": "SUZANNE",
        "middle_name": "GRACE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "34-005775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, OH

All providers in Fremont, OH · Emergency Medicine Physician in Ohio

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.