1770570459 NPI number — SUSAN FORT SORDONI MD

Table of content: SUSAN FORT SORDONI MD (NPI 1770570459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770570459 NPI number — SUSAN FORT SORDONI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SORDONI
Provider First Name:
SUSAN
Provider Middle Name:
FORT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770570459
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 PIERCE ST
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18704-5149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-714-2999
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/29/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD072550L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20 3165381 . This is a "GREAT WEST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7822738 . This is a "AETNA PPL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1058606 . This is a "AETNA MC ADVANTAGE & HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20 3165381 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 61056770 . This is a "DEPT OF LABOR FECA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0018304560003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 203165381 . This is a "DEVON HEALTH CARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 002782 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: BS7070701 . This is a "DEA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 193973 . This is a "BLUE CROSS-BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 60162 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0018304560003 . This is a "MED PLUS-3 RIVERS-UNASYN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20 3165381 . This is a "INTERGROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20 3165381 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".