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NPI Code Detail

MEDICARE: AITA KAI SUSI MD

MEDICARE:   AITA KAI SUSI  MD
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
12084P0800XPsychiatry PhysicianMD053877LPA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2340035FPXOTHERPAMEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number : 1336137249
Entity Type Code : Individual
Provider Name (Legal Business Name) : AITA KAI SUSI MD
Provider Business Mailing Address
First Line : 1640 OAKWOOD DR APT W109
Second Line :
City : PENN VALLEY
State : PA
Zip : 19072-1035
Country : US
Telephone Number : 610-308-8454
Fax Number :
Provider Business Practice Location Address
First Line : 28 GARRETT AVE
Second Line :
City : BRYN MAWR
State : PA
Zip : 19010-1400
Country : US
Telephone Number : 610-308-8454
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2005
Last Update Date : 02/27/2025

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Directions to “ AITA KAI SUSI MD” Practice Location

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