Basic Information
| Provider Information | |||||||||
| NPI: | 1396173019 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEIN | ||||||||
| FirstName: | SUZAN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1307 FEDERAL ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152124769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122811757 | ||||||||
| FaxNumber: | 4122817274 | ||||||||
| Practice Location | |||||||||
| Address1: | 1307 FEDERAL ST STE 107 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152124769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122811757 | ||||||||
| FaxNumber: | 4122817274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2013 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | MA056394 | PA | N | Allopathic & Osteopathic Physicians | Urology | 363AM0700X | MA056394 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 336486NHM | 05 | PA | MEDICAID | 12712551 | 01 | CAQH | OTHER |