Provider Demographics
NPI:1306829023
Name:BOSS, SUSAN A (PA-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:BOSS
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 1:2380 MCGINLEY RD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-4400
Mailing Address - Country:US
Mailing Address - Phone:412-856-2440
Mailing Address - Fax:412-856-4334
Practice Address - Street 1:2380 MCGINLEY RD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-4400
Practice Address - Country:US
Practice Address - Phone:412-856-2440
Practice Address - Fax:412-856-4334
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001776L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S47693Medicare UPIN
086878Medicare ID - Type Unspecified