Healthcare Provider Details

I. General information

NPI: 1265470736
Provider Name (Legal Business Name): SARUN SUWAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 UNION AVE
NATRONA HEIGHTS PA
15065-2134
US

IV. Provider business mailing address

1629 UNION AVE
NATRONA HEIGHTS PA
15065-2134
US

V. Phone/Fax

Practice location:
  • Phone: 724-224-4600
  • Fax: 724-224-2775
Mailing address:
  • Phone: 724-224-4600
  • Fax: 724-224-2775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD072491L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: