Provider Demographics
NPI:1790820249
Name:KURUVILLA, SUSAN M (MD)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:KURUVILLA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:7500 CENTRAL AVENUE
Mailing Address - Street 2:SUITE 100, PHYSICIAN'S OFFICE BUILDING
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111
Mailing Address - Country:US
Mailing Address - Phone:215-728-2020
Mailing Address - Fax:215-728-2044
Practice Address - Street 1:7500 CENTRAL AVENUE
Practice Address - Street 2:SUITE 100, PHYSICIANS OFFICE BUILDING
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111
Practice Address - Country:US
Practice Address - Phone:215-728-2020
Practice Address - Fax:215-728-2044
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2011-12-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD046860L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine