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General NPI Number Information
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NPI Number | 1558584037
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Entity Type | Individual
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Provider Name | LAURA SU MD. PHD.
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Gender | Female
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | PHILADELPHIA VA MEDICAL CENTER 3900 WOODLAND AVENUE
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City | PHILADELPHIA
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State | PA
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Zip | 19104-5000
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Country | US
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Telephone | 650-283-5556
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Fax |
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Provider Business Mailing Address
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Address Line | 2414 LOMBARD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19146-1023
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Country | US
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Telephone | 650-283-5556
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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 | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | A87919
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | MD450517
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License Number State | PA
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