Provider Demographics
NPI:1922072594
Name:HAINLEY, SUSAN BETH (DO)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:BETH
Last Name:HAINLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 BRADLEY WAY
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-5223
Mailing Address - Country:US
Mailing Address - Phone:814-695-2509
Mailing Address - Fax:
Practice Address - Street 1:153 BRADLEY WAY
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-5223
Practice Address - Country:US
Practice Address - Phone:814-695-2509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005366L174400000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001447522Medicaid
PA001447522Medicaid
PA059680PEEMedicare ID - Type Unspecified