Provider Demographics
NPI:1073754388
Name:JOHN H SUSZ DPM, PC
Entity Type:Organization
Organization Name:JOHN H SUSZ DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:SUSZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:814-331-2583
Mailing Address - Street 1:514 SPRINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-5301
Mailing Address - Country:US
Mailing Address - Phone:814-726-1864
Mailing Address - Fax:814-757-7785
Practice Address - Street 1:1 TIMBERVIEW LN
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:PA
Practice Address - Zip Code:16345-4149
Practice Address - Country:US
Practice Address - Phone:814-757-8204
Practice Address - Fax:814-757-7785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005569213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102278875Medicaid
PA147637Medicare PIN
PA102278875Medicaid