Basic Information
| Provider Information | |||||||||
| NPI: | 1285961458 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRIEGER | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KRIEGER | ||||||||
| OtherFirstName: | SUSAN | ||||||||
| OtherMiddleName: | E | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2134 SANDY DR STE 16 | ||||||||
| Address2: | |||||||||
| City: | STATE COLLEGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168032292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142725805 | ||||||||
| FaxNumber: | 8142720110 | ||||||||
| Practice Location | |||||||||
| Address1: | 2134 SANDY DR STE 16 | ||||||||
| Address2: | |||||||||
| City: | STATE COLLEGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168032292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142725805 | ||||||||
| FaxNumber: | 8142720110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2009 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 207RH0002X | MD460444 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | 207R00000X | MD460444 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1285961458 | 01 | PA | HIGHMARK | OTHER | 6498247 | 01 | PA | CIGNA | OTHER | 50150528 | 01 | PA | CAPITAL BC | OTHER | 103302115 | 05 | PA | MEDICAID |