Provider Demographics
NPI:1609854595
Name:BURSCH, SUSAN D (DO)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:BURSCH
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 1:1010 LIGONIER ST
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1846
Mailing Address - Country:US
Mailing Address - Phone:724-537-8518
Mailing Address - Fax:724-537-6613
Practice Address - Street 1:1010 LIGONIER ST STE 101
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1846
Practice Address - Country:US
Practice Address - Phone:724-537-8518
Practice Address - Fax:724-537-6613
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004942L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001302955003Medicaid
PA487370Medicare PIN
PA001302955003Medicaid