Provider Demographics
NPI:1538187398
Name:WEST, SUSAN E (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:WEST
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:833 CHESTNUT ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4414
Mailing Address - Country:US
Mailing Address - Phone:215-955-8465
Mailing Address - Fax:215-955-2516
Practice Address - Street 1:833 CHESTNUT ST
Practice Address - Street 2:SUITE 220
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4414
Practice Address - Country:US
Practice Address - Phone:215-955-8465
Practice Address - Fax:215-955-2516
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-03-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD039746E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7710003Medicaid
PA001122723Medicaid
PA001122723Medicaid