Basic Information
| Provider Information | |||||||||
| NPI: | 1295832970 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PANAH | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | SARAH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 STATE ST STE 103 | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165071450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148777157 | ||||||||
| FaxNumber: | 8148772844 | ||||||||
| Practice Location | |||||||||
| Address1: | 18 WEST MAIN | ||||||||
| Address2: | |||||||||
| City: | MT. JEWETT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147782298 | ||||||||
| FaxNumber: | 8147787344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2006 | ||||||||
| LastUpdateDate: | 08/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OS014335 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 102100438 | 05 | PA | MEDICAID |