MEDICARE: SUSAN BERARDINELLI PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	MA002245L	PA

General Provider Information

NPI Number	:	1043357577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN BERARDINELLI PA-C

Provider Business Mailing Address
First Line	:	1086 FRANKLIN ST
Second Line	:
City	:	JOHNSTOWN
State	:	PA
Zip	:	15905-4305
Country	:	US
Telephone Number	:	814-410-8300
Fax Number	:	814-410-8331

Provider Business Practice Location Address
First Line	:	3670 PORTAGE ST
Second Line	:
City	:	PORTAGE
State	:	PA
Zip	:	15946-6546
Country	:	US
Telephone Number	:	814-736-9614
Fax Number	:	814-736-9783

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	06/04/2025

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Directions to “ SUSAN BERARDINELLI PA-C” Practice Location

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