Provider Demographics
NPI:1043309602
Name:DELUCA, SUZANNE POLCYN (PT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:POLCYN
Last Name:DELUCA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:864 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-2516
Mailing Address - Country:US
Mailing Address - Phone:610-581-0111
Mailing Address - Fax:
Practice Address - Street 1:34 GREYTHORNE WOODS CIR
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-4758
Practice Address - Country:US
Practice Address - Phone:610-995-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT 013396L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5936658OtherAETNA PPO
PA2124448000OtherPERSONAL CHOICE (INDEPBC)
PA5936658OtherAETNA PPO