MEDICARE: DR. SUSAN ANGELISANTI M.D.

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	MD072027L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2451692000	OTHER	PA	INDEPENDENCE BLUE CROSS
2	000000222335-HBP	OTHER	PA	UNISON
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000000222333-PCP	OTHER	PA	UNISON
5	001769844	OTHER	PA	HIGHMARK
6	20064465	OTHER	PA	MERCY
7	50070801	OTHER	PA	CAPITAL BLUE CROSS/KEYSTONE HEALTH PLAN CENTRAL
8	1545407	OTHER	PA	GATEWAY

General Provider Information

NPI Number	:	1891790572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN ANGELISANTI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 783311
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19178-3311
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 NORMAL AVE
Second Line	:
City	:	KUTZTOWN
State	:	PA
Zip	:	19530-1640
Country	:	US
Telephone Number	:	610-683-5522
Fax Number	:

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	01/28/2016

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Directions to “ DR. SUSAN ANGELISANTI M.D.” Practice Location

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