Healthcare Provider Details

I. General information

NPI: 1679763338
Provider Name (Legal Business Name): SUSAN K UY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 STATE RD #2-900
DREXEL HILL PA
19026-4605
US

IV. Provider business mailing address

5030 STATE RD
DREXEL HILL PA
19026-4605
US

V. Phone/Fax

Practice location:
  • Phone: 610-623-9080
  • Fax: 610-623-3861
Mailing address:
  • Phone: 610-623-9080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS014153
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9899059
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA
# 2
Identifier50072147
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerKEYSTONE CAPITAL BC
# 3
Identifier003081
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerFIRST PRIORITY HEALTH
# 4
Identifier86121
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerGEISINGER HEALTH PLAN
# 5
Identifier1020095540001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 6
IdentifierUY001979354
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: