Healthcare Provider Details

I. General information

NPI: 1093239006
Provider Name (Legal Business Name): MRS. SUZANNE K TEPPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 08/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 ANNS CHOICE WAY
WARMINSTER PA
18974-3527
US

IV. Provider business mailing address

5525 RESEARCH PARK DRIVE 4TH FLOOR
BALTIMORE MD
21228-9999
US

V. Phone/Fax

Practice location:
  • Phone: 215-443-3850
  • Fax: 215-443-3963
Mailing address:
  • Phone: 215-443-3850
  • Fax: 215-443-3963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW014993
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: