Individual
CONSTANCE B SUTILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
255 W LANCASTER AVE, PAOLI, PA 19301-1763
(610) 429-0693
Mailing address
255 W LANCASTER AVE, PAOLI, PA 19301-1763
(610) 429-0693
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD052888L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014903450007
—
PA
01
—
0149034502
AMERICHOICE
PA
01
—
0730214000
KEYSTONE HEALTHPLAN EAST
PA
01
—
0847310
AETNA
PA
01
—
489045
BLUE SHIELD PA
PA
Enumeration date
10/26/2006
Last updated
10/04/2007
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