Healthcare Provider Details

I. General information

NPI: 1710940663
Provider Name (Legal Business Name): SUZI LEIDIG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 N 21ST ST
CAMP HILL PA
17011-2204
US

IV. Provider business mailing address

503 N 21ST ST
CAMP HILL PA
17011-2204
US

V. Phone/Fax

Practice location:
  • Phone: 717-763-2219
  • Fax: 717-763-2272
Mailing address:
  • Phone: 717-972-7919
  • Fax: 717-763-2272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD070309L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberMD070309L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: