Provider Demographics
NPI:1992842462
Name:STEVENS, SUSAN THERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:THERESA
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:THERESA
Other - Last Name:CARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:810 CLAIRTON BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-4567
Mailing Address - Country:US
Mailing Address - Phone:412-466-5004
Mailing Address - Fax:412-466-7137
Practice Address - Street 1:810 CLAIRTON BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-4567
Practice Address - Country:US
Practice Address - Phone:412-466-5004
Practice Address - Fax:412-466-7137
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR1886208000000X
PAMD445733208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027610600002Medicaid