=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467452052
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUZANNE M STEPANSKI M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2005
-----------------------------------------------------
Last Update Date | 10/19/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2407 REICHART RD
-----------------------------------------------------
City | BLOOMSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17815-8969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-784-8303
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 N ACADEMY AVE
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17822-4903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-271-6144
-----------------------------------------------------
Fax | 570-271-6578
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OS015842
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------