Provider Demographics
NPI:1225221930
Name:MARGARYAN, SUSANNA (MD)
Entity type:Individual
Prefix:
First Name:SUSANNA
Middle Name:
Last Name:MARGARYAN
Suffix:
Gender:F
Credentials:MD
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 398
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17508-0398
Mailing Address - Country:US
Mailing Address - Phone:717-556-1600
Mailing Address - Fax:717-556-1632
Practice Address - Street 1:169 MARTIN AVE
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1724
Practice Address - Country:US
Practice Address - Phone:717-733-6546
Practice Address - Fax:717-733-6010
Is Sole Proprietor?:No
Enumeration Date:2007-08-26
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD443516207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102638058Medicaid
226035Medicare PIN