Provider Demographics
NPI:1770570459
Name:SORDONI, SUSAN FORT (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:FORT
Last Name:SORDONI
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: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:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072550L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018304560003OtherMED PLUS-3 RIVERS-UNASYN
PA20 3165381OtherGREAT WEST
PA0018304560003Medicaid
PA20 3165381OtherINTERGROUP
PA1058606OtherAETNA MC ADVANTAGE & HMO
PA193973OtherBLUE CROSS-BLUE SHIELD
PA203165381OtherDEVON HEALTH CARE
PA7822738OtherAETNA PPL
PA002782OtherFIRST PRIORITY HEALTH
PA20 3165381OtherUNITED HEALTHCARE
PA60162OtherGEISINGER
PA20 3165381OtherHEALTH AMERICA
PA61056770OtherDEPT OF LABOR FECA
PA61056770OtherDEPT OF LABOR FECA
PA0018304560003Medicaid
PA044945XABMedicare PIN
PA61056770OtherDEPT OF LABOR FECA