Healthcare Provider Details

I. General information

NPI: 1316109960
Provider Name (Legal Business Name): SUSAN MARIE LAURENCE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN MARIE MARCHIANO DO

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W LANCASTER AVE
PAOLI PA
19301-1763
US

IV. Provider business mailing address

255 W LANCASTER AVE
PAOLI PA
19301-1763
US

V. Phone/Fax

Practice location:
  • Phone: 484-565-1510
  • Fax: 484-565-1512
Mailing address:
  • Phone: 484-565-1510
  • Fax: 484-565-1512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS014867
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: