Provider Demographics
NPI:1447468970
Name:BERKE, SUSANNAH ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:SUSANNAH
Middle Name:ELIZABETH
Last Name:BERKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:980 BEAVER GRADE RD
Mailing Address - Street 2:SUITE 10A
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2774
Mailing Address - Country:US
Mailing Address - Phone:412-262-4911
Mailing Address - Fax:
Practice Address - Street 1:980 BEAVER GRADE RD
Practice Address - Street 2:SUITE 10A
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-2774
Practice Address - Country:US
Practice Address - Phone:412-262-4911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD454158207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD389PMedicare PIN
MD1477641447OtherMEDICARE RAILROAD GROUP