Provider Demographics
NPI:1326054586
Name:RHEINGOLD, SUSAN R (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:RHEINGOLD
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:100 E PENN SQ
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9258
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:CHILDREN'S HOSPITAL OF PHILADELPHIA - HEM/ONC
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:215-590-3535
Practice Address - Fax:215-590-3992
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-03-16
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Provider Licenses
StateLicense IDTaxonomies
PAMD055510L208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7291400Medicaid
PA001634169Medicaid
NJ7291400Medicaid
NJ7291400Medicaid