MEDICARE: DR. HENRY H. SU D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	OS009559L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174594253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY H. SU D.O.

Provider Business Mailing Address
First Line	:	1412-22 FAIRMOUNT AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-2908
Country	:	US
Telephone Number	:	215-684-5344
Fax Number	:	215-232-4093

Provider Business Practice Location Address
First Line	:	841 E HUNTING PARK AVE
Second Line	:	SUITE 201
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-4800
Country	:	US
Telephone Number	:	215-537-7695
Fax Number	:	215-537-7001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	09/24/2021

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Directions to “ DR. HENRY H. SU D.O.” Practice Location

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