Provider Demographics
NPI: | 1528363108 |
---|---|
Name: | IORFIDO, SUZANNE MARIE (DO) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | SUZANNE |
Middle Name: | MARIE |
Last Name: | IORFIDO |
Suffix: | |
Gender: | F |
Credentials: | DO |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 100 HOSPITAL AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | DU BOIS |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 15801-1440 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 814-375-3261 |
Mailing Address - Fax: | 814-375-3397 |
Practice Address - Street 1: | 100 HOSPITAL AVE |
Practice Address - Street 2: | |
Practice Address - City: | DU BOIS |
Practice Address - State: | PA |
Practice Address - Zip Code: | 15801-1440 |
Practice Address - Country: | US |
Practice Address - Phone: | 814-375-3261 |
Practice Address - Fax: | 814-375-3397 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2011-01-13 |
Last Update Date: | 2018-03-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | OT013550 | 207R00000X |
MI | 5101019530 | 207RG0300X |
DC | DO034553 | 2085R0202X |
PA | OS018885 | 2085R0202X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
No | 207RG0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |