Provider Demographics
NPI:1104983089
Name:SCHWARTZ, SUSAN F (M D)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:F
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:PA
Mailing Address - Zip Code:16023-1256
Mailing Address - Country:US
Mailing Address - Phone:724-360-0200
Mailing Address - Fax:724-360-0200
Practice Address - Street 1:561 N PIKE RD
Practice Address - Street 2:
Practice Address - City:SARVER
Practice Address - State:PA
Practice Address - Zip Code:16055-8513
Practice Address - Country:US
Practice Address - Phone:724-360-0274
Practice Address - Fax:724-360-0200
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042767E207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7190570Medicaid
PA7190570Medicaid
PA425723Medicare ID - Type Unspecified