Individual
MR. FRED M SUSICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1070 OLD NATIONAL PIKE, FREDERICKTOWN, PA 15333-2114
(724) 632-6801
(724) 632-6312
Mailing address
1070 OLD NATIONAL PIKE, FREDERICKTOWN, PA 15333-2114
(724) 632-6801
(724) 632-6312
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
107288440051
—
PA
01
—
328834A336347
VALUE BEHAVIORAL HEALTH
PA
Enumeration date
01/21/2011
Last updated
01/21/2011
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