Provider Demographics
NPI:1215986864
Name:SHORTEN, SUZANNE
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:SHORTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 MARYLAND RD
Mailing Address - Street 2:SUITE #400
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1216
Mailing Address - Country:US
Mailing Address - Phone:215-481-3064
Mailing Address - Fax:
Practice Address - Street 1:1116 HORSHAM RD
Practice Address - Street 2:SUITE 10
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-1143
Practice Address - Country:US
Practice Address - Phone:215-643-8500
Practice Address - Fax:215-643-6999
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420374207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA420374Medicare PIN