Provider Demographics
NPI:1114094679
Name:MARSHALL, SUSAN B (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:B
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:G
Other - Last Name:BRASSIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6104 FAYETTEVILLE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6283
Mailing Address - Country:US
Mailing Address - Phone:919-908-6446
Mailing Address - Fax:919-381-5020
Practice Address - Street 1:6104 FAYETTEVILLE RD STE 101
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6283
Practice Address - Country:US
Practice Address - Phone:919-908-6446
Practice Address - Fax:919-381-5020
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10418363AM0700X
NC0010-00700363AM0700X
NC0010-0700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ75741Medicare UPIN