Healthcare Provider Details

I. General information

NPI: 1164558433
Provider Name (Legal Business Name): SUSAN V. ESTRADA, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 EDGEWOOD DRIVE EXTENSION
TRANSFER PA
16154
US

IV. Provider business mailing address

13 STONEY BROOK BLVD
GREENVILLE PA
16125-7803
US

V. Phone/Fax

Practice location:
  • Phone: 724-646-0400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD 062293 L
License Number StatePA

VIII. Authorized Official

Name: DR. SUSAN VICTORIA ESTRADA-TE
Title or Position: ADMINISTRATOR
Credential:
Phone: 724-347-0861