Individual
DR. GREGORY R. SUSLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-4353
(215) 707-2781
Mailing address
PO BOX 447, DU BOIS, PA 15801-0447
(814) 371-2200
(814) 375-4232
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
MD-050303-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000449333
BLUE CROSS
PA
05
—
001437535
—
PA
Enumeration date
07/30/2006
Last updated
08/20/2020
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