Provider Demographics
NPI:1891790572
Name:ANGELISANTI, SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:ANGELISANTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 NORMAL AVE
Practice Address - Street 2:
Practice Address - City:KUTZTOWN
Practice Address - State:PA
Practice Address - Zip Code:19530-1640
Practice Address - Country:US
Practice Address - Phone:610-683-5522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072027L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2451692000OtherINDEPENDENCE BLUE CROSS
PA000000222335-HBPOtherUNISON
PA1014183360001Medicaid
PA000000222333-PCPOtherUNISON
PA001769844OtherHIGHMARK
PA20064465OtherMERCY
PA50070801OtherCAPITAL BLUE CROSS/KEYSTONE HEALTH PLAN CENTRAL
PA1545407OtherGATEWAY
PA50070801OtherCAPITAL BLUE CROSS/KEYSTONE HEALTH PLAN CENTRAL
PA000000222335-HBPOtherUNISON