Provider Demographics
NPI:1083849673
Name:GLOD, SUSAN MARIAN (LAC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARIAN
Last Name:GLOD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 VANDERBILT DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1322
Mailing Address - Country:US
Mailing Address - Phone:412-552-0486
Mailing Address - Fax:
Practice Address - Street 1:2101 GREENTREE RD
Practice Address - Street 2:SUITE A-204
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-1400
Practice Address - Country:US
Practice Address - Phone:412-279-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM000082171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist