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General NPI Number Information
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NPI Number | 1467419192
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Entity Type | Individual
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Provider Name | SUSAN B RAGONESI M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 06/13/2012
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Provider Practice Location Address
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Address Line | 2527 S BROAD ST 1ST FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19148-4309
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Country | US
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Telephone | 215-755-4640
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Fax | 215-755-4576
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Provider Business Mailing Address
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Address Line | 2527 S BROAD ST 1ST FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19148-4309
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Country | US
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Telephone | 215-755-4640
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Fax | 215-755-4576
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD030257E
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License Number State | PA
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