Provider Demographics
NPI:1336183482
Name:NG, SU-ANN (MD)
Entity Type:Individual
Prefix:
First Name:SU-ANN
Middle Name:
Last Name:NG
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 1:1255 S CEDAR CREST BLVD STE 2500
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6240
Mailing Address - Country:US
Mailing Address - Phone:610-770-1606
Mailing Address - Fax:
Practice Address - Street 1:1255 S CEDAR CREST BLVD STE 2500
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6240
Practice Address - Country:US
Practice Address - Phone:610-770-1606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA938302085R0202X
PAMD4454532085R0202X
ND112472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A938300OtherBS
CACG1263OtherRAILROAD MEDICARE
CA00A938300Medicaid
CAWA93830CMedicare PIN
CAWA93830FMedicare PIN
CA00A93800Medicare PIN
CA00A938300Medicaid
CAWA93830AMedicare PIN
CAWA93830DMedicare PIN
CAWA93830BMedicare PIN
CAWA93830EMedicare PIN
BI311ZMedicare PIN
CAWA93830GMedicare PIN
NDN714467Medicare PIN