Provider Demographics
NPI:1619908027
Name:PAINTER, SUSAN GERALINE (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:GERALINE
Last Name:PAINTER
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 1:785 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-709-6529
Practice Address - Street 1:50 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:PA
Practice Address - Zip Code:17225-1100
Practice Address - Country:US
Practice Address - Phone:717-597-5553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005772L207P00000X, 207R00000X
OH34004821207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000561010OtherANTHEM
OH2309844Medicaid
OH000000381808OtherANTHEM
OH2309844Medicaid
OHPA4226741Medicare PIN
OHPA4226742Medicare PIN
OH000000561010OtherANTHEM
OH$$$$$$$$$-00OtherOH BWC
OHPA4226743Medicare PIN