Provider Demographics
NPI:1841431681
Name:GORE, SUZETTE (LOM)
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:
Last Name:GORE
Suffix:
Gender:F
Credentials:LOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 DIAMOND DR
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-2428
Mailing Address - Country:US
Mailing Address - Phone:215-397-8963
Mailing Address - Fax:
Practice Address - Street 1:940 TOWN CENTER DR
Practice Address - Street 2:SUITE F-90
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1772
Practice Address - Country:US
Practice Address - Phone:215-397-8963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM000043171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist