Provider Demographics
NPI:1396871497
Name:SUSAN J PROBST, MD & ASSOCIATES
Entity type:Organization
Organization Name:SUSAN J PROBST, MD & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PROBST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-376-3700
Mailing Address - Street 1:740 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1006
Mailing Address - Country:US
Mailing Address - Phone:610-376-3700
Mailing Address - Fax:610-685-1567
Practice Address - Street 1:740 PENN AVE
Practice Address - Street 2:
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1006
Practice Address - Country:US
Practice Address - Phone:610-376-3700
Practice Address - Fax:610-685-1567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038524L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1538197348OtherNPI
PA1538197348OtherNPI