Individual
SUSANNA PANTELYAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2112 WELSH RD, PHILADELPHIA, PA 19115
(215) 673-1498
(215) 673-4299
Mailing address
2112 WELSH RD, PHILADELPHIA, PA 19115
(215) 673-1498
(215) 673-4299
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
25MA07382000
NJ
2084N0400X
Neurology Physician
Primary
MD417337
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001871360
—
PA
01
—
30009182
KEYSTONE MERCY
PA
01
—
A3226157
AETNA
PA
Enumeration date
10/05/2006
Last updated
09/22/2011
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