Provider Demographics
NPI:1538233275
Name:WILLIAMS, SUSAN L (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1553 CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:CRUM LYNNE
Mailing Address - State:PA
Mailing Address - Zip Code:19022-1022
Mailing Address - Country:US
Mailing Address - Phone:610-499-7180
Mailing Address - Fax:610-876-0859
Practice Address - Street 1:1553 CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:CRUM LYNNE
Practice Address - State:PA
Practice Address - Zip Code:19022-1022
Practice Address - Country:US
Practice Address - Phone:610-499-7180
Practice Address - Fax:610-876-0859
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2011-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD027086E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000881147Medicaid
PA99222Medicare PIN
PA000881147Medicaid