Provider Demographics
NPI:1811018740
Name:BLYDENBURGH, SUSAN MELISSA (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MELISSA
Last Name:BLYDENBURGH
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
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Mailing Address - Street 1:915 BRINTONS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-8109
Mailing Address - Country:US
Mailing Address - Phone:610-256-9285
Mailing Address - Fax:610-793-1423
Practice Address - Street 1:915 BRINTONS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-8109
Practice Address - Country:US
Practice Address - Phone:610-256-9285
Practice Address - Fax:610-793-1423
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD034393E2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine