Provider Demographics
NPI:1346211414
Name:SU, SEAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:C
Last Name:SU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 STATE ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-1830
Mailing Address - Country:US
Mailing Address - Phone:814-456-2457
Mailing Address - Fax:814-456-7679
Practice Address - Street 1:2910 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1832
Practice Address - Country:US
Practice Address - Phone:814-454-5686
Practice Address - Fax:814-454-8946
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD057015L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01645289Medicare ID - Type UnspecifiedPROMISE