Provider Demographics
NPI:1427749316
Name:SURMA, EDWARD SHAWN (MED LBS)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:SHAWN
Last Name:SURMA
Suffix:
Gender:M
Credentials:MED LBS
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 82
Mailing Address - Street 2:
Mailing Address - City:PLEASANT UNITY
Mailing Address - State:PA
Mailing Address - Zip Code:15676-0082
Mailing Address - Country:US
Mailing Address - Phone:412-610-3429
Mailing Address - Fax:
Practice Address - Street 1:4731 ROUTE 30 STE 404
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-7260
Practice Address - Country:US
Practice Address - Phone:724-850-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001933103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst