Provider Demographics
NPI:1093022543
Name:THAN, NAW SUSAN
Entity Type:Individual
Prefix:MS
First Name:NAW
Middle Name:SUSAN
Last Name:THAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 HADDON AVE RM 122
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-3101
Mailing Address - Country:US
Mailing Address - Phone:856-886-5222
Mailing Address - Fax:
Practice Address - Street 1:200 BOWMAN DR STE E385
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9638
Practice Address - Country:US
Practice Address - Phone:856-840-4534
Practice Address - Fax:856-762-2853
Is Sole Proprietor?:No
Enumeration Date:2010-09-04
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014150363A00000X
NJ25MP00414700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant