MEDICARE: SUZANNE KOZIOL PUGH M.D.

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	207V00000X	Obstetrics & Gynecology Physician	MD445644	PA

General Provider Information

NPI Number	:	1952381196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE KOZIOL PUGH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 22581
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-2581
Country	:	US
Telephone Number	:	610-482-4795
Fax Number	:	856-528-3117

Provider Business Practice Location Address
First Line	:	85 OLD EAGLE SCHOOL RD
Second Line	:
City	:	STRAFFORD
State	:	PA
Zip	:	19087-2556
Country	:	US
Telephone Number	:	610-688-3744
Fax Number	:

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

Provider Enumeration Date	:	01/21/2006
Last Update Date	:	06/28/2021

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