Individual
MRS. SUSAN ANN FORTNAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED., P.A.-C
Contact information
Practice address
5230 CENTRE AVE, M 216 PHYSICIAN ASSISTANT OFFICE, PITTSBURGH, PA 15232-1304
(412) 263-9714
Mailing address
5749 WESLEYANN DR, GIBSONIA, PA 15044-9448
(724) 444-4884
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA000055L
PA
Other
Enumeration date
07/08/2013
Last updated
07/08/2013
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