Provider Demographics
NPI:1750493441
Name:SUSQUEHANNA UROLOGIC ASSOCIATES LTD
Entity Type:Organization
Organization Name:SUSQUEHANNA UROLOGIC ASSOCIATES LTD
Other - Org Name:SUSQUEHANNA UROLOGIC ASSOCIATES LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MANSUY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-326-8090
Mailing Address - Street 1:1705 WARREN AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701
Mailing Address - Country:US
Mailing Address - Phone:570-326-8090
Mailing Address - Fax:570-326-7513
Practice Address - Street 1:1705 WARREN AVE STE 206
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701
Practice Address - Country:US
Practice Address - Phone:570-326-8090
Practice Address - Fax:570-326-7513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty