Basic Information
| Provider Information | |||||||||
| NPI: | 1619908027 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAINTER | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | GERALINE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVE STE 3 | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7177096529 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 EASTERN AVE | ||||||||
| Address2: | |||||||||
| City: | GREENCASTLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172251100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175975553 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 03/20/2019 | ||||||||
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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 | 207P00000X | OS005772L | PA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 34004821 | OH | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | OS005772L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000561010 | 01 | OH | ANTHEM | OTHER | 2309844 | 05 | OH | MEDICAID | 000000381808 | 01 | OH | ANTHEM | OTHER |