Provider Demographics
NPI:1114962800
Name:SZEWCZAK, SUZANN (DO)
Entity Type:Individual
Prefix:DR
First Name:SUZANN
Middle Name:
Last Name:SZEWCZAK
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:PO BOX 1111
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-0907
Mailing Address - Country:US
Mailing Address - Phone:215-453-4995
Mailing Address - Fax:215-453-4646
Practice Address - Street 1:658 HARLEYSVILLE PIKE
Practice Address - Street 2:SUITE 120
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-2886
Practice Address - Country:US
Practice Address - Phone:215-256-9655
Practice Address - Fax:215-256-9868
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS011853207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7945500OtherAETNA
PA001875968Medicaid
PA1344872OtherHIGHMARK BLUE SHIELD
PA0029803OtherCIGNA HEALTHCARE
PA2038783000OtherINDEPENDENCE BLUE CROSS
PA001875968Medicaid
PA054705Medicare PIN