Provider Demographics
NPI:1487765269
Name:STOUDT, SUSAN R (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:STOUDT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:694 GOOD DR
Mailing Address - Street 2:SUITE 11
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2433
Mailing Address - Country:US
Mailing Address - Phone:717-544-3737
Mailing Address - Fax:717-544-3739
Practice Address - Street 1:694 GOOD DR
Practice Address - Street 2:SUITE 11
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2433
Practice Address - Country:US
Practice Address - Phone:717-544-3737
Practice Address - Fax:717-544-3739
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD060560L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5220006OtherUSH/HMO
PA50051205OtherCAPITAL BLUE CROSS
PA1513423OtherGATEWAY
PA158150OtherBLUE SHIELD
PA172516OtherTHREE RIVERS
PA5220706OtherAETNA
PA17271410007Medicaid
PA160048491OtherRRMCR
PA160048491OtherRRMCR
PA5220706OtherAETNA