Provider Demographics
NPI:1093711574
Name:PAK-LEE, SUSAN (DO)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:PAK-LEE
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 1:1665 BUSTLETON PIKE
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-7305
Mailing Address - Country:US
Mailing Address - Phone:215-355-9770
Mailing Address - Fax:215-355-2246
Practice Address - Street 1:1665 BUSTLETON PIKE
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE
Practice Address - State:PA
Practice Address - Zip Code:19053-7305
Practice Address - Country:US
Practice Address - Phone:215-355-9770
Practice Address - Fax:215-355-2246
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008557L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA771224Medicare PIN