Healthcare Provider Details

I. General information

NPI: 1013918697
Provider Name (Legal Business Name): SUSQUEHANNA VALLEY PEDIATRICS, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 E MOUNTAIN AVE
SOUTH WILLIAMSPORT PA
17702-7628
US

IV. Provider business mailing address

6 E MOUNTAIN AVE
SOUTH WILLIAMSPORT PA
17702-7628
US

V. Phone/Fax

Practice location:
  • Phone: 570-321-1665
  • Fax: 570-321-1824
Mailing address:
  • Phone: 570-321-1665
  • Fax: 570-321-1824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK G. ODORIZZI
Title or Position: PRESIDENT
Credential: D.O.
Phone: 570-321-1665