Provider Demographics
NPI:1528036266
Name:BRANTON, SUSAN ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ANN
Last Name:BRANTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ANN
Other - Last Name:KNAUBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1201 GRAMPIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 GRAMPIAN BLVD
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1909
Practice Address - Country:US
Practice Address - Phone:570-326-8200
Practice Address - Fax:570-320-7540
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2019-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055568L2086X0206X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018602030006Medicaid
PA50054306OtherCAPITAL BLUE CROSS
PAG69503OtherHEALTHAMERICA
PA277234OtherHIGHMARK BLUE SHIELD
PA5865633OtherAETNA
PA817181OtherFIRST PRIORITY HEALTH
PA1763662OtherUNITEDHEALTHCARE
PA0018602030005Medicaid
PAP00051274Medicare PIN
PA50054306OtherCAPITAL BLUE CROSS