Provider Demographics
NPI:1194301275
Name:SUZANA STEPANEK MD
Entity type:Organization
Organization Name:SUZANA STEPANEK MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SUZANA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPANEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-238-5667
Mailing Address - Street 1:210 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-1106
Mailing Address - Country:US
Mailing Address - Phone:724-238-5667
Mailing Address - Fax:
Practice Address - Street 1:210 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-1106
Practice Address - Country:US
Practice Address - Phone:724-238-5667
Practice Address - Fax:888-364-8834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-20
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD062765LOtherLICENSE NUMBER
PAMD06265LOtherLICENSE NUMBER