{
"Npi": {
"NPI": "1710365473",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MEDALIE",
"FirstName": "SUSAN",
"MiddleName": "RACHEL",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "D.O.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2100 MACK BLVD FL 4",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ALLENTOWN",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "18103-5622",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "570-790-2391",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "200 SCHUYLKILL MEDICAL PLZ",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "POTTSVILLE",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "17901-3660",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "570-621-9270",
"PracticeLocationAddressFaxNumber": "570-621-9271",
"EnumerationDate": "05/14/2015",
"LastUpdateDate": "02/06/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "OS018728",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}