Provider Demographics
NPI:1538118203
Name:KATARA, SUMAN (MD)
Entity Type:Individual
Prefix:
First Name:SUMAN
Middle Name:
Last Name:KATARA
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:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-0432
Mailing Address - Country:US
Mailing Address - Phone:570-807-2372
Mailing Address - Fax:570-421-5251
Practice Address - Street 1:3 PARKINSON RD STE C
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8087
Practice Address - Country:US
Practice Address - Phone:570-517-7382
Practice Address - Fax:570-421-5251
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD419281208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008582400002Medicaid
PA1639354OtherHIGHMARK BLUE SHIELD
PA1008582400002Medicaid
PA1639354OtherHIGHMARK BLUE SHIELD