Individual
SUSAN J BACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3401 CIVIC CENTER BLVD, CHILDREN'S HOSPITAL OF PHILADELPHIA - RADIOLOGY, PHILADELPHIA, PA 19104-4319
(215) 590-7000
(215) 590-9348
Mailing address
100 E PENN SQ, 9TH FLOOR, PHILADELPHIA, PA 19107-3323
(267) 425-9234
(267) 425-9299
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
MD429646
PA
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
MD429646
PA
2085B0100X
Body Imaging Physician
MT184561
PA
2085R0202X
Diagnostic Radiology Physician
Primary
MD429646
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
03/06/2007
Last updated
05/30/2013
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