Basic Information
| Provider Information | |||||||||
| NPI: | 1487765269 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STOUDT | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 694 GOOD DR | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176012433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175443737 | ||||||||
| FaxNumber: | 7175443739 | ||||||||
| Practice Location | |||||||||
| Address1: | 694 GOOD DR | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176012433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175443737 | ||||||||
| FaxNumber: | 7175443739 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 02/06/2017 | ||||||||
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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 | 207V00000X | MD060560L | PA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 5220006 | 01 | PA | USH/HMO | OTHER | 50051205 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 1513423 | 01 | PA | GATEWAY | OTHER | 158150 | 01 | PA | BLUE SHIELD | OTHER | 172516 | 01 | PA | THREE RIVERS | OTHER | 5220706 | 01 | PA | AETNA | OTHER | 17271410007 | 05 | PA | MEDICAID | 160048491 | 01 | PA | RRMCR | OTHER |