Provider Demographics
NPI:1093999344
Name:SUSAN L PELUSO, PHD MD, INC
Entity Type:Organization
Organization Name:SUSAN L PELUSO, PHD MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FALKENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-998-4924
Mailing Address - Street 1:550 STANTON CHRISTIANA RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2198
Mailing Address - Country:US
Mailing Address - Phone:302-998-4924
Mailing Address - Fax:
Practice Address - Street 1:550 STANTON CHRISTIANA RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2198
Practice Address - Country:US
Practice Address - Phone:302-998-4924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10005321207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG80753Medicare UPIN
DEG010137Medicare PIN