Provider Demographics
NPI:1679763338
Name:UY, SUSAN K (DO)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:UY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 STATE RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-4605
Mailing Address - Country:US
Mailing Address - Phone:610-623-9080
Mailing Address - Fax:
Practice Address - Street 1:5030 STATE RD
Practice Address - Street 2:#2-900
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-4605
Practice Address - Country:US
Practice Address - Phone:610-623-9080
Practice Address - Fax:610-623-3861
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014153208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
9899059OtherAETNA
PA50072147OtherKEYSTONE CAPITAL BC
PA003081OtherFIRST PRIORITY HEALTH
PA86121OtherGEISINGER HEALTH PLAN
PA1020095540001Medicaid
PAUY001979354OtherHIGHMARK BS
PA003081OtherFIRST PRIORITY HEALTH