Healthcare Provider Details

I. General information

NPI: 1629127378
Provider Name (Legal Business Name): SUSAN W. SOMERSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 FRANKFORD AVE
PHILADELPHIA PA
19124-2618
US

IV. Provider business mailing address

307 S EVERGREEN AVE
WOODBURY NJ
08096-2739
US

V. Phone/Fax

Practice location:
  • Phone: 215-612-4963
  • Fax: 215-807-8235
Mailing address:
  • Phone: 856-686-4300
  • Fax: 215-807-8235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberVP003429B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: