Provider Demographics
NPI:1124369038
Name:CASTNER, SUZANNE FARHANG (PA-C)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:FARHANG
Last Name:CASTNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 E MONUMENT ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-5327
Mailing Address - Country:US
Mailing Address - Phone:410-327-5100
Mailing Address - Fax:
Practice Address - Street 1:10910 LITTLE PATUXENT PKWY
Practice Address - Street 2:200
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3078
Practice Address - Country:US
Practice Address - Phone:410-997-2770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004999363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical