Provider Demographics
NPI:1912958570
Name:KOSTENBLATT, SUSAN E (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:KOSTENBLATT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1605 N CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 110B
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2351
Mailing Address - Country:US
Mailing Address - Phone:610-973-1410
Mailing Address - Fax:610-973-1449
Practice Address - Street 1:4520 PARK VIEW DR
Practice Address - Street 2:
Practice Address - City:SCHNECKSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18078-2552
Practice Address - Country:US
Practice Address - Phone:610-799-4241
Practice Address - Fax:484-403-4008
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD028675E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01054104OtherCAPITAL BLUE CROSS
PA404772OtherHIGHMARK PA BLUE SHIELD
PA080050616OtherPALMETTO RR
PA404772OtherHIGHMARK PA BLUE SHIELD
PA404772KZJMedicare PIN
PAB41262Medicare UPIN