Provider Demographics
NPI:1093924201
Name:SLUSS, NICHOLAS J (PA)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:J
Last Name:SLUSS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 COEBURN AVE SW
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-2606
Mailing Address - Country:US
Mailing Address - Phone:276-679-0800
Mailing Address - Fax:276-679-0097
Practice Address - Street 1:338 COEBURN AVE SW
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-2606
Practice Address - Country:US
Practice Address - Phone:276-679-0800
Practice Address - Fax:276-679-0097
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA0110002484363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA26-3425063OtherTAX ID #
VAVV7525B288Medicare PIN