Provider Demographics
NPI:1356322374
Name:MCGARY, SUZAN ANNETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZAN
Middle Name:ANNETTE
Last Name:MCGARY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUZAN
Other - Middle Name:ANNETTE
Other - Last Name:AUFIERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1140 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3618
Mailing Address - Country:US
Mailing Address - Phone:570-326-1100
Mailing Address - Fax:
Practice Address - Street 1:1140 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3618
Practice Address - Country:US
Practice Address - Phone:570-326-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043543E208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30122967OtherAMERIHEALTH MERCY - WMG
PA1585016OtherGATEWAY
PA160449OtherHIGHMARK BLUE SHIELD
PA0017479590001Medicaid
PA0017479590001Medicaid
PA1585016OtherGATEWAY