Provider Demographics
NPI:1295832970
Name:PANAH, SUSAN SARAH (DO)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:SARAH
Last Name:PANAH
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 1:333 STATE ST STE 103
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1450
Mailing Address - Country:US
Mailing Address - Phone:814-877-7157
Mailing Address - Fax:814-877-2844
Practice Address - Street 1:18 WEST MAIN
Practice Address - Street 2:
Practice Address - City:MT. JEWETT
Practice Address - State:PA
Practice Address - Zip Code:16740
Practice Address - Country:US
Practice Address - Phone:814-778-2298
Practice Address - Fax:814-778-7344
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014335207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102100438Medicaid