Provider Demographics
NPI:1174596423
Name:DEAKIN, SUSAN L (DO)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:L
Last Name:DEAKIN
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 1:5375 WILLIAM FLYNN HWY
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-9666
Mailing Address - Country:US
Mailing Address - Phone:724-444-4700
Mailing Address - Fax:724-444-4730
Practice Address - Street 1:5375 WILLIAM FLYNN HWY
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-9666
Practice Address - Country:US
Practice Address - Phone:724-444-4700
Practice Address - Fax:724-444-4730
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008315L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016479620005Medicaid
PA002100R7RMedicare PIN
PA0016479620005Medicaid