Provider Demographics
NPI:1386613891
Name:ROITMAN, SUSAN (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:ROITMAN
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 22581
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-2581
Mailing Address - Country:US
Mailing Address - Phone:610-482-4795
Mailing Address - Fax:856-528-3117
Practice Address - Street 1:799 GAY ST
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-4409
Practice Address - Country:US
Practice Address - Phone:610-935-0644
Practice Address - Fax:610-935-7757
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-041936-E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012410810005Medicaid
PA0503347000OtherKEYSTONE HEALTH PLAN EAST
PA30018348OtherKEYSTONE MERCY
PA670209OtherHIGHMARK BLUE SHIELD
PA0503347000OtherPERSONAL CHOICE
PA3716811OtherAETNA
PA0012410810005Medicaid
PA670209TGWMedicare ID - Type UnspecifiedMEDICARE