Provider Demographics
NPI:1538133673
Name:ARISUMI, SUSAN K (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:K
Last Name:ARISUMI
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 1:100 N ACADEMY AVE
Mailing Address - Street 2:CREDENTIALS DEPT
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:250 REITZ BLVD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9208
Practice Address - Country:US
Practice Address - Phone:570-523-0055
Practice Address - Fax:570-523-7996
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036378E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001116922Medicaid
PA518782Medicare ID - Type Unspecified
PA001116922Medicaid