Provider Demographics
NPI:1003880055
Name:CHOI, SUSAN WOLLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:WOLLIN
Last Name:CHOI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:1246 STATE ROUTE 38
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-3217
Practice Address - Country:US
Practice Address - Phone:607-687-6101
Practice Address - Fax:607-687-5994
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042209E207R00000X
NY181337-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01222040Medicaid
NY110224587OtherRR MEDICARE PIN
NYCC8362OtherRR MEDICARE GROUP
PA0012258470003Medicaid
PA0012258470003Medicaid
NYCC8362OtherRR MEDICARE GROUP