Provider Demographics
NPI:1245209063
Name:KUCIRKA, SUSAN JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JEAN
Last Name:KUCIRKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 INDEPENDENCE DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SCHNECKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18078
Mailing Address - Country:US
Mailing Address - Phone:610-769-4200
Mailing Address - Fax:610-769-4204
Practice Address - Street 1:4110 INDEPENDENCE DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SCHNECKSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18078
Practice Address - Country:US
Practice Address - Phone:610-769-4200
Practice Address - Fax:610-769-4204
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031979E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA159570SGJMedicare ID - Type Unspecified
B40047Medicare UPIN