Provider Demographics
NPI:1033120746
Name:KIRCHDOERFFER, SUSAN (DO)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KIRCHDOERFFER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1098 W BALTIMORE PIKE
Mailing Address - Street 2:SUITE 3101
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5139
Mailing Address - Country:US
Mailing Address - Phone:610-891-9277
Mailing Address - Fax:610-891-7778
Practice Address - Street 1:1098 W BALTIMORE PIKE
Practice Address - Street 2:SUITE 3101
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5139
Practice Address - Country:US
Practice Address - Phone:610-891-9277
Practice Address - Fax:610-891-7778
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0005798207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA350616UCAOtherMEDICARE
DE0001166503Medicaid
DE009160Medicare ID - Type Unspecified
DE0001166503Medicaid