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General NPI Number Information
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NPI Number | 1851437958
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Entity Type | Individual
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Provider Name | KELLY SANSOUCI GIDUSKO MD
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Gender | Female
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 111 S FRONT ST
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City | HARRISBURG
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State | PA
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Zip | 17101-2010
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Country | US
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Telephone | 717-782-5118
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Fax | 717-782-5854
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Provider Business Mailing Address
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Address Line | 111 S FRONT ST
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City | HARRISBURG
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State | PA
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Zip | 17101-2010
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Country | US
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Telephone | 717-782-5118
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Fax | 717-782-5854
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD430016
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License Number State | PA
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