Provider Demographics
NPI:1477652196
Name:SUAREZ-FAVETTA, MILITZA E (MD)
Entity Type:Individual
Prefix:
First Name:MILITZA
Middle Name:E
Last Name:SUAREZ-FAVETTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 BOWMAN ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-5448
Mailing Address - Country:US
Mailing Address - Phone:570-823-5808
Mailing Address - Fax:570-970-2725
Practice Address - Street 1:1 KIM AVE STE 2
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-9101
Practice Address - Country:US
Practice Address - Phone:570-996-6555
Practice Address - Fax:570-996-6557
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05929800207R00000X, 207RI0200X
PAMD041299E207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C33820Medicare UPIN