MEDICARE: SUSAN LEIGH MOWATT MD

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	207Q00000X	Family Medicine Physician	MD071840L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699743450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN LEIGH MOWATT MD

Provider Business Mailing Address
First Line	:	619 CHURCH ST
Second Line	:	PO BOX 635
City	:	HAWLEY
State	:	PA
Zip	:	18428-1444
Country	:	US
Telephone Number	:	570-226-6077
Fax Number	:	570-561-2082

Provider Business Practice Location Address
First Line	:	619 CHURCH ST
Second Line	:
City	:	HAWLEY
State	:	PA
Zip	:	18428-1444
Country	:	US
Telephone Number	:	570-226-6077
Fax Number	:	570-561-2082

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	03/12/2010

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