Provider Demographics
NPI:1679511091
Name:STEPANEK, SUZANA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANA
Middle Name:
Last Name:STEPANEK
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 1:210 WEST CHURCH STREET
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658
Mailing Address - Country:US
Mailing Address - Phone:724-238-5667
Mailing Address - Fax:888-364-8834
Practice Address - Street 1:210 WEST CHURCH STREET
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658
Practice Address - Country:US
Practice Address - Phone:724-238-5667
Practice Address - Fax:888-364-8834
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA062765L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA964901OtherHIGHMARK
PA964901OtherHIGHMARK
PA159013Medicare PIN