Provider Demographics
NPI:1336137249
Name:SUSI, AITA KAI (MD)
Entity type:Individual
Prefix:
First Name:AITA
Middle Name:KAI
Last Name:SUSI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 OAKWOOD DR APT W109
Mailing Address - Street 2:
Mailing Address - City:PENN VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19072-1035
Mailing Address - Country:US
Mailing Address - Phone:610-308-8454
Mailing Address - Fax:
Practice Address - Street 1:28 GARRETT AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1400
Practice Address - Country:US
Practice Address - Phone:610-308-8454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053877L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001548356Medicaid
PA340035FPXOtherMEDICARE PTAN
PA001548356Medicaid