Provider Demographics
NPI:1932169828
Name:CONNOR, SUSAN ANN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANN
Last Name:CONNOR
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 1:240 ALLEGHENY BLVD.
Mailing Address - Street 2:STE F
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825
Mailing Address - Country:US
Mailing Address - Phone:814-849-3033
Mailing Address - Fax:814-849-1963
Practice Address - Street 1:240 ALLEGHENY BLVD.
Practice Address - Street 2:STE. F
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825
Practice Address - Country:US
Practice Address - Phone:814-849-3033
Practice Address - Fax:814-849-1963
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019990E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006025360003Medicaid
PA060305Medicare ID - Type Unspecified
PAC28632Medicare UPIN