Provider Demographics
NPI:1972708857
Name:SUSAN F. SORDONI, MD PC
Entity Type:Organization
Organization Name:SUSAN F. SORDONI, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PRACTICE PHYSICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:SORDONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-714-2999
Mailing Address - Street 1:PO BOX 1164
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-0164
Mailing Address - Country:US
Mailing Address - Phone:570-714-2999
Mailing Address - Fax:570-714-2903
Practice Address - Street 1:250 PIERCE ST
Practice Address - Street 2:SUITE 115
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5149
Practice Address - Country:US
Practice Address - Phone:570-714-2999
Practice Address - Fax:570-714-2903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072550L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1058606OtherAETNA MC ADVANTAGE & HMO
PA0018304560003OtherMED PLUS 3 RIVERS UNASYN
PA61056770OtherDEPARTMENT OF LABOR
PA0018304560003Medicaid
PA7822738OtherAETNA PPL
PA002782OtherFIRST PRIORITY
PA193973OtherBLUE CROSS BLUE SHIELD
PA60162OtherGEISINGER
PA0018304560003Medicaid
PA002782OtherFIRST PRIORITY
PA=========OtherINTERGROUP
PA0018304560003OtherMED PLUS 3 RIVERS UNASYN
PA61056770OtherDEPARTMENT OF LABOR
PA=========OtherINTERGROUP
PA=========OtherHEALTH AMERICA