1932540937 NPI number — MRS. SUSAN ANN FORTNAM M.ED., P.A.-C

Table of content: MRS. SUSAN ANN FORTNAM M.ED., P.A.-C (NPI 1932540937)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932540937 NPI number — MRS. SUSAN ANN FORTNAM M.ED., P.A.-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORTNAM
Provider First Name:
SUSAN
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED., P.A.-C
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:
1932540937
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5749 WESLEYANN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GIBSONIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15044-9448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-444-4884
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5230 CENTRE AVE
Provider Second Line Business Practice Location Address:
M 216 PHYSICIAN ASSISTANT OFFICE
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15232-1304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-263-9714
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2013

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: 363AM0700X , with the licence number:  MA000055L , 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)





Copyright © 2007-2025 www.npivalidator.com