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General NPI Number Information
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NPI Number | 1154620755
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Entity Type | Individual
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Provider Name | SUSAN SOTARDI MD
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Gender | Female
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Dates
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Enumeration Date | 03/22/2011
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Last Update Date | 06/15/2018
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Provider Practice Location Address
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Address Line | 3401 CIVIC CENTER BLVD DEPARTMENT OF RADIOLOGY
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City | PHILADELPHIA
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State | PA
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Zip | 19104
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Country | US
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Telephone | 215-590-1959
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Fax |
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Provider Business Mailing Address
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Address Line | 3401 CIVIC CENTER BLVD DIVISION OF RADIOLOGY
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City | PHILADELPHIA
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State | PA
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Zip | 19104
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Country | US
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Telephone | 215-590-1959
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 265233
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MT214851
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD463185
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License Number State | PA
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