Healthcare Provider Details

I. General information

NPI: 1639198435
Provider Name (Legal Business Name): SUSAN B CONLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 A ST
PHILADELPHIA PA
19134-1043
US

IV. Provider business mailing address

3601 A ST
PHILADELPHIA PA
19134-1043
US

V. Phone/Fax

Practice location:
  • Phone: 215-427-5190
  • Fax: 215-427-5351
Mailing address:
  • Phone: 215-427-5190
  • Fax: 215-427-5351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberMD063184L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number25MA07963200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: