Provider Demographics
NPI:1790736734
Name:SUSZ, JOHN H (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:SUSZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 SPRINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-5301
Mailing Address - Country:US
Mailing Address - Phone:814-331-2583
Mailing Address - Fax:814-757-7785
Practice Address - Street 1:1 TIMBERVIEW LN
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:PA
Practice Address - Zip Code:16345-4149
Practice Address - Country:US
Practice Address - Phone:814-757-8204
Practice Address - Fax:814-757-7785
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005569213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102278875Medicaid
PA102278875Medicaid
PA147637Medicare PIN