Healthcare Provider Details

I. General information

NPI: 1164679122
Provider Name (Legal Business Name): SUMATHI SUPPIAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 N SUSQUEHANNA TRL SUIT A
YORK PA
17404-8495
US

IV. Provider business mailing address

PO BOX 909
YORK PA
17405-0909
US

V. Phone/Fax

Practice location:
  • Phone: 717-812-0731
  • Fax: 717-812-9848
Mailing address:
  • Phone: 717-815-2555
  • Fax: 717-854-1434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD443124
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: