Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MD058519L | PA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | MD058519L | PA |
NPI | 1396742409 |
---|---|
Provider Name | Dr. Suzette J. Song |
First Address | York, PA 17402-4723 |
Second Address | York, PA 17402-4723 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2005 |
Last Update Date | 30/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G86898 | (02) |