MEDICARE: SUSAN FORT SORDONI 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
1	207Q00000X	Family Medicine Physician	MD072550L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0018304560003	OTHER	PA	MED PLUS-3 RIVERS-UNASYN
2	20 3165381	OTHER	PA	GREAT WEST
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	20 3165381	OTHER	PA	INTERGROUP
5	1058606	OTHER	PA	AETNA MC ADVANTAGE & HMO
6	193973	OTHER	PA	BLUE CROSS-BLUE SHIELD
7	203165381	OTHER	PA	DEVON HEALTH CARE
8	7822738	OTHER	PA	AETNA PPL
9	002782	OTHER	PA	FIRST PRIORITY HEALTH
10	20 3165381	OTHER	PA	UNITED HEALTHCARE
11	60162	OTHER	PA	GEISINGER
12	20 3165381	OTHER	PA	HEALTH AMERICA
13	61056770	OTHER	PA	DEPT OF LABOR FECA

General Provider Information

NPI Number	:	1770570459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN FORT SORDONI MD

Provider Business Mailing Address
First Line	:	PO BOX 1164
Second Line	:
City	:	KINGSTON
State	:	PA
Zip	:	18704-0164
Country	:	US
Telephone Number	:	570-714-2999
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 PIERCE ST
Second Line	:	SUITE 115
City	:	KINGSTON
State	:	PA
Zip	:	18704-5149
Country	:	US
Telephone Number	:	570-714-2999
Fax Number	:

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

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	03/07/2023

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