Provider Demographics
NPI:1720194525
Name:WABLE, SURESH G (MD)
Entity Type:Individual
Prefix:
First Name:SURESH
Middle Name:G
Last Name:WABLE
Suffix:
Gender:M
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 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:215-807-8000
Mailing Address - Fax:215-807-8235
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:EMERGENCY MEDICINE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1436
Practice Address - Country:US
Practice Address - Phone:215-612-4000
Practice Address - Fax:215-612-4532
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD064913L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01715810-04OtherAMERICHOICE-FF
PA0017158100007Medicaid
PA01715810-02OtherAMERICHOICE FT
PA179271OtherHIGHMARK BLUE SHIELD
PA0017158100006Medicaid
PA01715810-03OtherAMERICHOICE-FB
PA07645OtherHEALTH PARTNERS
PA1090529OtherKEYSTONE MERCY
PA2393702OtherCIGNA
PA0017158100008Medicaid
PA20035429OtherAMERIHEALTH MERCY
PA452729OtherAETNA CONTRACT
PA0229031000OtherKEYSTONE, IBC
PA930068037OtherRAILROAD MEDICARE
PA179271OtherHIGHMARK BLUE SHIELD
PA0017158100006Medicaid