Individual
DR. SUSAN A INNISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
132 S 10TH ST, 285K, 2ND FLOOR, PHILADELPHIA, PA 19107-5244
(215) 503-5642
(215) 503-4817
Mailing address
132 S 10TH ST, 285K, 2ND FLOOR, PHILADELPHIA, PA 19107-5244
(215) 503-5642
(215) 503-4817
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
MD057153L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001635756
—
PA
05
—
10052005426152
—
PA
Enumeration date
10/12/2005
Last updated
06/09/2016
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