1649352535 NPI number — DR. SUSAN LINDA PELUSO PHP MD

Table of content: DR. SUSAN LINDA PELUSO PHP MD (NPI 1649352535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649352535 NPI number — DR. SUSAN LINDA PELUSO PHP MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PELUSO
Provider First Name:
SUSAN
Provider Middle Name:
LINDA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHP 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:
1649352535
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 STANTON-CHRISTIANA RD SUITE 301
Provider Second Line Business Mailing Address:
WHITE CLAY CREEK MEDICAL CENTER
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-998-4924
Provider Business Mailing Address Fax Number:
302-998-4904

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 STANTON-CHRISTIANA RD SUITE 301
Provider Second Line Business Practice Location Address:
WHITE CLAY CREEK MEDICAL CENTER
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-998-4924
Provider Business Practice Location Address Fax Number:
302-998-4904
Provider Enumeration Date:
10/19/2006

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: 207R00000X , with the licence number:  C10005321 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: O43698681 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: O43698681 . This is a "TRI-CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: O68446883 . This is a "BCBS OF DELAWARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43698681 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: O43698681 . This is a "MID-ATLANTIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 180637 . This is a "COVENTRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 642624 . This is a "BCBS OF PA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8103356 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: O43698681 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: O68446883 . This is a "GREAT WEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: OOO1050501 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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