Provider Demographics
NPI:1336329671
Name:SUSCO, BENJAMIN MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:MARK
Last Name:SUSCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:125 N FRANKLIN DR STE 1
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-5892
Mailing Address - Country:US
Mailing Address - Phone:724-225-6500
Mailing Address - Fax:724-229-2170
Practice Address - Street 1:125 N FRANKLIN DR STE 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-5892
Practice Address - Country:US
Practice Address - Phone:724-225-6500
Practice Address - Fax:724-229-2170
Is Sole Proprietor?:No
Enumeration Date:2007-11-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD445023207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5914761Medicaid
WV3810019029Medicaid
OH0103045Medicaid
PA1029181870001Medicaid
PA1029181870001Medicaid
NC2075990Medicare PIN
NC5914761Medicaid