Provider Demographics
NPI:1457591331
Name:BAROODY, SUSAN MARY (DO)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARY
Last Name:BAROODY
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 1:221 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:OLYPHANT
Mailing Address - State:PA
Mailing Address - Zip Code:18447-1475
Mailing Address - Country:US
Mailing Address - Phone:570-383-3636
Mailing Address - Fax:570-383-3638
Practice Address - Street 1:221 RIVER ST
Practice Address - Street 2:
Practice Address - City:OLYPHANT
Practice Address - State:PA
Practice Address - Zip Code:18447-1475
Practice Address - Country:US
Practice Address - Phone:570-383-3636
Practice Address - Fax:570-383-3638
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015260207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine