MEDICARE: SUSANNAH M. STAIR 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	208000000X	Pediatrics Physician	MD423727	PA
2	207R00000X	Internal Medicine Physician	MD423727	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1629736	OTHER	PA	HIGHMARK PIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972595387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANNAH M. STAIR MD

Provider Business Mailing Address
First Line	:	2925 WILLIAM PENN HWY STE 201
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18045-5283
Country	:	US
Telephone Number	:	106-258-1400
Fax Number	:	833-932-1218

Provider Business Practice Location Address
First Line	:	2925 WILLIAM PENN HWY STE 201
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18045-5283
Country	:	US
Telephone Number	:	610-258-1400
Fax Number	:	833-932-1218

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	02/28/2024

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