Individual
AITA KAI SUSI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
28 GARRETT AVE, BRYN MAWR, PA 19010-1400
(610) 308-8454
Mailing address
1640 OAKWOOD DR APT W109, PENN VALLEY, PA 19072-1035
(610) 308-8454
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD053877L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001548356
—
PA
01
—
340035FPX
MEDICARE PTAN
PA
Enumeration date
10/13/2005
Last updated
02/27/2025
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